A curious case of ST elevation

Abstract

Takotsubu cardiomyopathy (TC) describes transient left ventricular apical ballooning due to akinetic myocardium. It mimics acute coronary syndrome, with similar electrocardiogram changes and raised troponin, but visible coronary artery stenosis is missing. Patients usually recall a preceding stressful event and post-menopausal women are at greatest risk. Aetiology of TC remains contentious, but the strongest theory suggests increased sympathetic nervous system activity resulting in elevated catecholamines, which culminates in cardiac manifestations. Treatment is supportive and complications include arrhythmias, cardiac rupture, thrombus formation and congestive cardiac failure. The prognosis is favourable and by definition cardiac function returns to pre-morbid levels. Mortality is rare (1-2%). © Royal College of Physicians, 2013.