Takotsubo cardiomyopathy: The challenging diagnosis in clinical routine

Abstract

Takotsubo cardiomyopathy is rapidly reversible heart failure syndrome that usually mimics the symptoms of acute myocardial infarction with the characteristic regional wall-motion abnormalities (classically with a virtual apical ballooning caused by hypokinetic or akinetic apical or midventricular myocardium and hypercontraction of the basal segments) and absence of obstructive coronary artery disease. TC is usually associated with identifiable emotional, psychological or physical stress event and most commonly appears in postmenopausal women. The certain pathophysiological mechanism remains unknown. However, the central hypothesis is supported by the excess of catecholamines and hyperactivity of nervous system. In the last decades the frequency of the TC diagnosis is increasing rapidly but at the initial presentation the diagnosis remains challenging due to the close similarities between TC and ST elevation myocardial infarction clinical presentations that consider TC as an important part of differential diagnosis in acute coronary syndrome.

A Rare Case of Takotsubo Syndrome and Acute Coronary Syndrome of the Right Coronary Artery

“…Catecholamine levels in takotsubo patients are 2-3 times higher than myocardial infarction patients 1-2 days after the onset of symptoms and 20 times higher than normal adults [18]. Additionally, the catecholamine levels in takotsubo patients remain elevated over myocardial infarction levels for 7-9 days [19]. With the known prothrombotic properties of catecholamines and the suspected rise in catecholamines associated with TTS, it is possible that TTS could have occurred first in our patient, leading to ACS of the RCA.…”

Takotsubo-Like Cardiomyopathy in Pheochromocytoma

“…Most cases of TTC feature complete resolution of LV function, in which only conservative treatment is sufficient 5 . However, a small subset of patients have potentially life-threatening complications during the initial presentation 2 .…”

An uncommon manifestation of shock: Takotsubo syndrome

“…Typically, LVOT obstruction occurs in TTS due to the hyperdynamic contraction of the basal segments of the left ventricle impairing cardiac output and causing cardiogenic shock (4). Due to the reduced cardiac output from the severely impaired ventricle, compensatory basal hyper-contractility occurs.…”