Takotsubo cardiomyopathy
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Takotsubo cardiomyopathy, also known as transient apical ballooning and stress-induced cardiomyopathy, is a type of non-ischemic cardiomyopathy in which there is a sudden temporary weakening of the myocardium (the muscle of the heart).
The typical presentation of someone with takotsubo cardiomyopathy is a sudden onset of congestive heart failure or chest pain associated with EKG changes suggestive of an anterior wall heart attack. During the course of evaluation of the patient, a bulging out of the left ventricular apex with a hypercontractile base of the left ventricle is often noted. It is the hallmark bulging out of the apex of the heart with preserved function of the base that earned the syndrome its name "tako tsubo", or octopus trap in Japan, where it was first described. Evaluation of individuals with takotsubo cardiomyopathy typically include a coronary angiogram, which will not reveal any significant blockages that would cause the left ventricular dysfunction. Provided that the individual survives their initial presentation, the left ventricular function improves within 2 months. Takotsubo cardiomyopathy is more commonly seen in post-menopausal women.[1] Often there is a history of a recent severe emotional or physical stress.[1]
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[edit] Etiology
The etiology of takotsubo cardiomyopathy is unknown. There is a correlation between severe stress and takotsubo cardiomyopathy.[2] It is possible that the cardiomyopathy is due to catecholamine release, as has been shown in experimental rat models.
[edit] Diagnosis
While the original case reports reported on individuals in Japan, takotsubo cardiomyopathy has been noted more recently in the United States and Western Europe. It is likely that the syndrome went previously undiagnosed before it was described in detail in the Japanese literature.
The diagnosis of takotsubo cardiomyopathy may be difficult upon presentation. The EKG findings are often confused with those found during an acute anterior wall myocardial infarction.[1][3]
The diagnosis is made by the pathognomic wall motion abnormalities, in which the base of the left ventricle is contracting normally or are hyperkinetic while the remainder of the left ventricle is akinetic or dyskinetic. This is accompanied by the lack of significant coronary artery disease that would explain the wall motion abnormalities.
[edit] Treatment
The treatment of takotsubo cardiomyopathy is generally supportive in nature. In individuals with hypotension, support with inotropic agents or an intra-aortic balloon pump have been used. In many individuals, left ventricular function normalizes within 2 months.[4][5]
[edit] References
- ^ a b c Azzarelli S, Galassi AR, Amico F, Giacoppo M, Argentino V, Tomasello SD, Tamburino C, Fiscella A. (2006). "Clinical features of transient left ventricular apical ballooning". Am J Cardiol. 98 (9): 1273-6. PMID 17056345.
- ^ Mitchell SA, Crone RA. (2006). "Takotsubo cardiomyopathy: a case report.". J Am Soc Echocardiogr 19 (9): 1190 e9-10. PMID 16950478.
- ^ Bybee KA, Motiei A, Syed IS, Kara T, Prasad A, Lennon RJ, Murphy JG, Hammill SC, Rihal CS, Wright RS (2006). "Electrocardiography cannot reliably differentiate transient left ventricular apical ballooning syndrome from anterior ST-segment elevation myocardial infarction". J Electrocardiol. PMID 17067626.
- ^ Akashi YJ, Nakazawa K, Sakakibara M, Miyake F, Koike H, Sasaka K. (2003). "The clinical features of takotsubo cardiomyopathy". QJM 96 (8): 563-73. PMID 12897341.
- ^ Nyui N, Yamanaka O, Nakayama R, Sawano M, Kawai S. (2000). "'Tako-Tsubo' transient ventricular dysfunction: a case report". Jpn Circ J 64 (9): 715-9. PMID 10981859.
