Takotsubo Cardiomyopathy: What we have Learned in the Last 25 Years? (A Comparative Literature Review)

Abstract

We performed a comparative literature review, to elucidate the major features of the Takotsubo (stress) cardiomyopathy (TCM) collected in last 25 years.TCM is characterized by left- or biventricular apical ballooning with a clinical presentation, electrocardiographic abnormalities, and biomarker profils similar to those seen in acute myocardial infarction. Epidemiological studies have shown that TCM is more common in postmenopausal women; however exact figures are not available. The underlying aetiology is still largely undetermined. Elevated catecholamine levels, lack of estrogen, disturbed myocardial fatty acid metabolism and plaque rupture with spontaneous thrombolysis are potentially discussed mechanisms responsible for inducing a prolonged stunned myocardium. Strong emotional or physical stress is the most frequently described trigger in the literature. Therapy recommendations include appropriate antiplatelet treatment, β-blockers and ACE inhibitors. The abnormal kinetics usually resolve or improve within a month and carry a favorable prognosis in most cases. However, all the suspected complications of an acute myocardial infarction, including cardiogenic shock or lethal arrhythmias, may still occur.

Delayed metabolic dysfunction in myocardium following exertional heat stroke in mice

“…An interesting and possibly related clinical condition is Takotsubo cardiomyopathy, a transient cardiomyopathy occurring predominantly in women (>90%) (Said et al . 2016). It is clinically characterized by ‘left ventricular apical ballooning in the presence of normal coronary arteries’ and is histologically characterized by the presence of increased inflammatory cells in the myocardium (Scally et al .…”

Permanent Pacemaker Implantation in a Patient with Takotsubo Cardiomyopathy and Complete Atrioventricular Block

“…Takotsubo cardiomyopathy (TCM) is known as stress-induced heart disease that occurs with transient acute left ventricle (LV) apical ballooning without coronary artery stenosis. Various pathogeneses of TCM are presumed, and strong emotional or physical stress has been reported to be triggers [ 1 ]. Various types of arrhythmias can complicate acute phase TCM, such as ventricular tachycardia, ventricular fibrillation, Torsades de pointes, atrial fibrillation, sinus node dysfunction, and atrioventricular (AV) block [ 1 – 3 ].…”

“…Various pathogeneses of TCM are presumed, and strong emotional or physical stress has been reported to be triggers [ 1 ]. Various types of arrhythmias can complicate acute phase TCM, such as ventricular tachycardia, ventricular fibrillation, Torsades de pointes, atrial fibrillation, sinus node dysfunction, and atrioventricular (AV) block [ 1 – 3 ]. Contrary to the reversible, transient pathophysiology of TCM alone, some cases of arrhythmia-complicated TCM developed into more life-threatening conditions, such as intermittent asystole or sudden cardiac death [ 2 ].…”

First report on biventricular stress cardiomyopathy with concomitant atrio-ventricular high-grade conduction disorder

“…At one one-year follow-up patient had remained free from cardiovascular symptoms and adverse cardiac events, though there was persistent high-degree AV block. Control echocardiogram demonstrated preserved left ventricular function (EF 60%) without wall motion abnormalities.Despite numerous known triggers [3][4][5], the underlying pathophysiological mechanism of timely stunned myocardium and AV conduction damage remains unclear. Whether AV blocks are the cause or consequence of TTC is still a matter of debate.…”

“…Despite numerous known triggers [3][4][5], the underlying pathophysiological mechanism of timely stunned myocardium and AV conduction damage remains unclear. Whether AV blocks are the cause or consequence of TTC is still a matter of debate.…”