Systematic Review: Transient Left Ventricular Apical Ballooning: A Syndrome That Mimics ST-Segment Elevation Myocardial Infarction

Abstract

The transient left ventricular apical ballooning syndrome, also known as takotsubo cardiomyopathy, is characterized by transient wall-motion abnormalities involving the left ventricular apex and mid-ventricle in the absence of obstructive epicardial coronary disease. In this paper, we review case series that report on patients with the transient left ventricular apical ballooning syndrome to better characterize patients presenting with the syndrome. We identified 7 case series that reported on at least 5 consecutive patients with the transient left ventricular apical ballooning syndrome. The syndrome more often affects postmenopausal women (82% to 100%) (mean age, 62 to 75 years). Patients commonly present with ST-segment elevation in the precordial leads, chest pain, relatively minor elevation of cardiac enzyme and biomarker levels, and transient apical systolic left ventricular dysfunction despite the absence of obstructive epicardial coronary disease. An episode of emotional or physiologic stress frequently precedes presentation with the syndrome. The in-hospital mortality rate seems to be low, as does the risk for recurrence.

Tako‐Tsubo Cardiomyopathy in Severe Sepsis: Nationwide Trends, Predictors, and Outcomes

“…First, this study duration coincided with the evolution of point‐of‐care cardiac ultrasonography in critical illness, resulting in the higher application and likely greater diagnosis of TTC at the bedside 29. Second, the initial TTC criteria were proposed in 2004 with a subsequent revision in 2008 that potentially resulted in the further unification of clinical definitions and higher awareness in treating physicians 2, 5. The first reported series of TTC in sepsis was in 2005, providing additional awareness 30.…”

“…Labeled variably as apical‐ballooning syndrome, stress cardiomyopathy, and broken‐heart syndrome, TTC is characterized by transient regional left ventricular systolic dysfunction without obstructive coronary artery disease, precipitated by emotional and physical triggers 1, 2. It is diagnosed most commonly in postmenopausal females, though it does occur in young women and males 1, 3.…”

Angry bowels breaking hearts: a case series

“…This phenomenon may be underestimated. There are reports that more than 2% of all patients presenting with ST-segment elevation myocardial infarctions to have Takotsubo cardiomyopathy as an underlying process [3]. …”

“…Transthoracic echocardiography can confirm resolution. While the prognosis is generally good, complications include left ventricular thrombus formation as well as incomplete resolution, and recurrences are described in up to 10% of patients [3]. …”

Takotsubo cardiomyopathy in a patient with an ascending colon mass

“…Takotsubo cardiomyopathy (TTC) is a transient phenomenon of myocardial hypo-contractility that occurs in the presence of physical or emotional stressors and involves non-obstructive coronary circulation [1]. Though Takotsubo is a temporary stress-related myocardial dysfunction, clinical presentation of TTC is often alarming as it mimics acute coronary syndrome (ACS), and therefore, necessitates angiography in most of the cases.…”