TakoTsubo Cardiomyopathy A Short Review

Abstract

Takotsubo cardiomyopathy (TCM), otherwise cardiomyopathy,apical ballooning syndrome or broken heart syndrome is a reversible cardiomyopathy, predominantly occurs in post-menopausal women and commonly due to emotional or physical stress. Typically, patients present with chest pain and ST elevation or T wave inversion on their electrocardiogram mimicking acute coronary syndrome, but with normal or non-flow limiting coronary artery disease. Acute dyspnoea, hypotension and even cardiogenic shock may be the presenting feature of this condition. The wall motion abnormalities typically involve akinesia of the apex of the left ventricle with hyperkinesia of the base of the heart. Atypical forms of TCM have also recently been described. An urgent left ventriculogram or echocardiogram is the key investigation to identify this syndrome. Characteristically, there is only a limited release of cardiac enzymes disproportionate to the extent of regional wall motion abnormality. Transient right ventricular dysfunction may occur and is associated with more complications, longer hospitalisation and worse left ventricular systolic dysfunction. Recently, cardiac MRI has been increasingly used to diagnose this condition and to differentiate from acute coronary syndrome in those who have abnormal coronary arteries. Treatment is often supportive, however beta-blocker and angiotensin-converting enzyme inhibitor or angiotensin II receptor blocking agent are being used in routine clinical practice. The syndrome is usually spontaneously reversible and cardiovascular function returns to normal after a few weeks. This review article will elaborate on the pathophysiology, clinical features including the variant forms, latest diagnostic tools, management and prognosis of this condition.

Takotsubo cardiomyopathy resulting from exacerbation of chronic pancreatitis

“…emotional stress) and physical (e.g. pheochromocytoma, sub-arachnoid hemorrhage, reperfusion injury) triggers have been reported previously [3,4]. Besides the causes of TCM presented above, also acute pancreatitis (via exaggeration of sympathetic stimulation that leads to transient myocardial dysfunction and microvascular hypoperfusion distributive shock) could act as a trigger for TCM.…”

Quercetin Inhibits Chronic Stress-Induced Myocardial Infarction in Rats

“…The ECG is the most important tool in the initial evaluation of patients suspect having acute coronary syndrome, such as MI, and ST segment elevation is a confirmed diagnosis of MI ( Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology et al, 2012). Severe emotional and / or physical stress in humans caused damage to the left ventricle and account for about 2 % of MI cases, mostly in women (Roshanzamir & Showkathali, 2013). In addition, majority of patients with MI developed LVD (Mateus et al, 2005).…”

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“…[1][2][3] It was first described in 1990 by Sato and associates. 4,5 The term "takotsubo" stands for octopus (Tako) pot (Tsubo) and resembles a widebased clay jar with a narrow neck and round bottom. Left ventriculography during systole in patients with TCM demonstrates such a shape.…”

“…4,7 The prevalence of TCM among patients presenting with symptoms of ACS is approximately 1% to 2.5%, with 90% of cases diagnosed in postmenopausal women. 4,5,7 The exact mechanism of TCM remains unknown. Various factors have been reported as the main triggers for developing this condition.…”

“…Generally, a stressor of some type is identifiable. 3,5,8 Until recently, the Mayo Clinic criteria, originally proposed in 2004 and subsequently modified in 2008, were the most widely used in clinical practice for the diagnosis of TCM. 3,4 Recently, new diagnostic criteria have been proposed by the Heart Failure Association of the European Society of Cardiology.…”