Takotsubo cardiomyopathy – a clinical review

Abstract

SummaryStress cardiomyopathy is characterised by reversible left ventricular dysfunction. It simulates an acute coronary syndrome (ACS), presenting with precordial pain or dyspnoea, changes of the ST segment, T wave, or QTc interval on electrocardiogram, and raised cardiac enzymes. Typical findings are disturbances of segmental contractility (apical hypokinesia or akinesia), with normal epicardial coronary arteries. The true prevalence is unknown, as the syndrome may be under-diagnosed; it is more common in postmenopausal women. There is usually a trigger in the form of physical or psychological stress. The electrocardiographic, echocardiographic, and ventriculographic changes resolve spontaneously over a variable period of time (from days to months). There are a number of pathophysiological theories, none of which has been shown to be definitive, suggesting that all of them may be involved to some extent. The prognosis is generally favourable, and recurrence is very rare.

A Variant form of Takotsubo Syndrome secondary to Sumatriptan: A case report

“…The true prevalence of TS is unclear and there are no clear risk factors associated with TS [2] . The diagnostic criteria remain controversial and multiple criteria have been presented in literature [4][5][6][7][8] .…”

“…The LV adopts a shape of a pot, thus receiving its name takotsubo syndrome (in Japanese takotsubo means an octopus trap). Typically, LV appears with a narrow base and globular apex but atypical forms and variants of takotsubo syndrome have been described and can comprise up to one third of the total presentations [2,9] (see Table 2). The exact mechanism and pathogenesis of this disorder is unknown.…”

“…Sympathetic nervous mechanisms causing release of catecholamine and giving myocardial stunning may also play a part in catecholamine-induced cardiotoxicity [1,19] . Low estrogen states increase the risk of microvascular dysfunction in high catecholamine conditions placing perimenopausal and postmenopausal women on higher risk to develop TS [2,20] .…”

“…It usually mimics an acute coronary syndrome presenting with chest pain or dyspnea, electrocardiographic abnormalities and elevated cardiac biomarkers [1] . It is characterized by an abnormal LV segmental contractility without any evidence of obstructive coronary artery disease [2] . Takotsubo syndrome is also known as stress induced cardiomyopathy, apical ballooning syndrome or "Broken heart syndrome".…”

Stress-induced cardiomyopathy

“…Presentation can include chest pain, ST segment elevations, rise in cardiac markers, heart failure, and characteristic apical and mid-segment hypokinesis with compensatory basal segment hyperkinesis, producing an apical ballooning, which gives the appearance of a Japanese octopus trap, ‘takotsubo’ (figure 1). 3…”