Takotsubo cardiomyopathy

Abstract

Takotsubo cardiomyopathy has been described as an acute, reversible heart failure syndrome that is increasingly recognized with the access to urgent coronary angiography for patients with acute cardiac chest pain. Takotsubo cardiomyopathy patients have frequently experienced an extremely stressful triggering event and are typically postmenopausal women. These patients usually present with features typical of acute myocardial infarction including chest pain, dyspnea, palpitations, increased serum troponin, and acute electrocardiogram (ECG) changes including ST elevation and/or T wave inversion. The characteristic appearance is hypokinesia of the apical and mid-left ventricular myocardium with basal hypercontractility that resembles the Japanese fisherman's octopus pot, the 'takotsubo.' This syndrome appears to reflect the cardiovascular response to a sudden surge in epinephrine levels, and may be a form of acute catecholaminergic stunning. Diagnosis requires exclusion of culprit obstructive coronary artery disease and recovery of the regional dysfunction. Patients may present to emergency services de novo, but Takotsubo cardiomyopathy may result in several acute medical and surgical conditions, and can be triggered by various drugs. Initially, there is a high-risk phase with several potential serious complications; therefore, access to high quality cardiac imaging is important to confirm the diagnosis, screen for complications, and confirm recovery at follow-up. Takotsubo cardiomyopathy cases with evidence of heart failure may require a short course of medical therapy; in severe cases, mechanical support as a "bridge to recovery" may be necessary.