Reversible ventricular dysfunction takotsubo cardiomyopathy

Abstract

Background: Recently, many cardiologists have recognized the existence of a rapidly reversible form of heart failure of unknown origin characterized by a takotsubo-shaped, dyskinetic left ventricle on left ventriculography. Aim: To determine the detailed clinical features of takotsubo cardiomyopathy. Methods: Thirteen elderly patients (11 women and 2 men with a mean age of 75.3 years) who had normal coronary arteries and takotsubolike left ventricular dysfunction were prospectively enrolled in this study. Results: Cardiac enzymes did not increase significantly, but the mean plasma norepinephrine level was very high on admission (0.98 Ag/l). Coronary angiography revealed normal coronary arteries in all patients, but left ventriculography showed apical akinesis combined with basal hyperkinesis, i.e., a takotsubo (Japanese octopus fishing pot)-shaped ventricle. Left ventricular wall motion normalized within a mean of 16.9 hospital days in 12 patients, but 1 patient died of acute renal failure on hospital day 7. Cardiac events did not recur during a follow-up period of 0.5 to 5 years. Conclusion: Takotsubo cardiomyopathy seems to be a new type of acute heart failure, which generally has a good prognosis and does not recur. Myocardial damage by catecholamine overload, adrenoceptor hypersensitivity, and changes of catecholamine dynamics due to stress may cause this condition.

Stress-Induced Cardiomyopathy in Sweden: Evidence for Different Ethnic Predisposition and Altered Cardio-Circulatory Status

“…We propose that low SVR may be either a compensatory mechanism operating to maintain normal cardiac output under resting conditions and/or an integral part of the SIC pathophysiology. In a previous study, it has been reported that cardiac output is decreased during the acute stage of SIC [29]. The reason for the discrepancy between our findings may be due to patient selection, different diagnostic criteria for SIC used and different timing of hemodynamic evaluation.…”

Takotsubo Cardiomyopathy

“…However, elevated catecholamine levels are not uniformly found in patients with this syndrome. 3 High plasma catecholamine levels in patients with pheochromocytoma are well known to induce reversible cardiomyopathy. 20 …”

“…It is important to pay attention to the hemodynamics in the acute phase, which often correspond to New York Heart Association class III heart failure. 3 Only a handful of recurrent takotsubo cardiomyopathy cases have been reported. Mechanisms underlying susceptibility to recurrence are not understood.…”

“…When shock occurs, intraaortic balloon pumping is established as additional support for the circulation. 3 We use upright posture, oxygen, and diuretics for pulmonary edema, although given the putative pathophysiological mechanism, it would be reasonable to treat pulmonary edema with sedation and morphine.…”

Clinical Characteristics and Outcomes of Takotsubo Cardiomyopathy

“…Intra-aortic balloon pump can be used to support the haemodynamic state in cardiogenic shock with or without LVOT obstruction. 63 The use of catecholamines as intotropic agents should be considered carefully in this situation, since catecholamines excess may play an important role in this condition and LVOT obstruction can be worsened. Levosimedan has been suggested, 64,65 although clinical data are limited to date.…”