Takotsubo cardiomyopathy: a diagnostic challenge

Abstract

The frequency of the diagnosis of takotsubo cardiomyopathy has increased rapidly over the past few years, possibly due to increasing awareness among cardiologists. At initial presentation the diagnosis remains a challenge because of the close similarity between the presentation of takotsubo cardiomyopathy, and that of ST elevation myocardial infarction (STEMI). Recognition of salient aspects of the medical history at presentation are important in order to organise further appropriate investigations such as echocardiography and left ventriculography at the time of coronary angiogram. Takotsubo cardiomyopathy can be easily missed without ventriculography early after presentation because of the transient nature of left ventricular dysfunction, and in many centres left ventriculogram is not done as standard in the setting of STEMI. The authors advocate left ventriculography in all cases of ST elevation who have unobstructed coronaries. The correct diagnosis of takotsubo cardiomyopathy is very important for future advice and management of the patient. The prognosis of this condition is generally excellent with almost all patients returning to normal within a few weeks. This article examines the takotsubo cardiomyopathy literature and discusses the pathophysiology, clinical features, management, and prognosis of this condition in the context of an illustrated case.

Takotsubo cardiomyopathy developing during recovery from general anesthesia: A case report

“…With the exception of cardiogenic shock at the time of first diagnosis in these patients in literature, short, medium and long-term prognoses have been reported to be close to excellent [8,18]. Even if left ventricle function is severely impaired on first presentation when diagnosis is made, recovery starts within a few days and with return to a normal state within a few months, normal functions have been reported to be maintained [8,19]. In the current case, cardiac functions started to improve within 12 hours and the supportive treatments were terminated.…”

Broken heart syndrome triggered by an obstructive goiter not associated with thyrotoxicosis

“…8 Many mechanisms are postulated to explain this phenomenon, but the most plausible is a rise in catecholamine levels and decreased blood flow in the myocardial microcirculation. 9 Right ventricular dysfunction may occur in approximately 25% of patients. This typically occurs in more severe cases, and patients may require IABP support.…”

“…Betablockade is recommended after recovery of myocardial function to prevent recurrence of TC. 9 The prognosis of TC is generally favourable, although fatal cases have been reported due to ventricular free-wall rupture. 11 Recurrence has been reported as high as 11%.…”

Stress-Induced Cardiomyopathy: Clinical Observations

“…Uchida et al also observed elevated levels of plasma epinephrine and norepinephrine in patients with stress-induced cardiomyopathy (Uchida et al, 2010). The plasma half-life of epinephrine is only 3 min (Zeb et al, 2011, as cited in Ferreira & Vane, 1967, so measurement of catecholamines should be conducted at the time of symptom onset.…”