Case Series of Takotsubo Cardiomyopathy

Abstract

Takotsubo cardiomyopathy, also known as apical ballooning syndrome or stress-induced cardiomyopathy, is characterized by reversible left ventricular segmental dysfunction. The incidence is disproportionately increased in elderly women and is precipitated by a stressful event. Pathophysiology is uncertain, but increased incidence in postmenopausal elderly women has implicated endocrine and hormonal mechanisms, including catecholamine excess, as the most favored explanations. The patients typically present with chest pain, ST segment changes on electrocardiogram, and increased cardiac biomarkers. Angiography is usually the first diagnostic test with evidence of apical ballooning or mid-ventricular dyskinesia/akinesia without significant epicardial coronary disease. Treatment is supportive and prognosis is good, especially in elderly female patients presenting with underlying emotional stressor as the inciting event. A subset of patients presenting with idiopathic or physiologic stress may be at increased risk of hemodynamic compromise requiring intensive hemodynamic support and monitoring. The jury is still out on disease pathogenesis, management, primary prevention, and long-term outcomes.