Abstract 41: Broken Heart Syndrome-“Not so rare anymore”

Abstract

Background: Takotsubo or stress induced cardiomyopathy (TCM), once considered rare is now an increasingly considered differential diagnosis in patients presenting as an acute myocardial infarction (MI). TCM is a rapidly reversible form of acute heart failure associated with a distinctive left ventricular contraction pattern and non-obstructive(<50% stenosis) coronary artery diseases(CAD) on cardiac catheterization(CC) Literature regarding this disease is relatively sparse with reports of incidence around 1%. Methods: Medical records were reviewed for patients, from 2006 onwards, with either a discharge diagnosis of TCM or a clinical presentation of ST elevation MI (STEMI) or a Non-STEMI (NSTEMI) and with ventriculogram on cardiac catheterizations (CC) but without any coronary interventions. We retrieved 972 patients and 99 met the criteria for TCM after a detailed review of their records. Findings: Our data showed that the diagnosis of TCM increased yearly from 2006 to 2011 presumably due to an increasing awareness of this entity. In 2011, 25 of 937 patients presumed to be a STEMI/NSTEMI were TCM (incidence of 2.7%). TCM patients were more likely to be older female patients (See figure for Demographics). A stressful trigger could be identified in 45 patients, the most common causes being death in the family, diagnosis of cancer or recent illness/surgery. Comorbidities included hypertension (57%), hyperlipidemia (55%), depression/anxiety(34%) , diabetes(22%), active smoking(16%) and chronic pain (24%).Follow up ECHO were available only in 69% and of theses completely recovery was seen in 73% ,partial recovery in 23% and minimal or no recovery in 4% of patients. All patients who showed no recovery had TCM in the postoperative period. Mortality was 5% during index hospitalization and all these patients were ICU patients (either postoperative or septic shock patients) Conclusions: TCM is becoming an increasing finding in the cardiac catheterization lab in patients presenting as an acute MI .Increasing awareness of this condition and performing a ventriculogram in these patients is necessary for diagnosis. Our study suggests that in ICU patients, a diagnosis of TCM portends a poor prognosis and TCM in the postoperative period may result in permanent cardiomyopathy.