Myocardial edema as a substrate of electrocardiographic abnormalities and life-threatening arrhythmias in reversible ventricular dysfunction of takotsubo cardiomyopathy: Imaging evidence, presumed mechanisms, and implications for therapy.

Abstract

Introduction Takotsubo cardiomyopathy (TTC) is a cardiovascular condition that mimics acute coronary syndrome because of its acute clinical presentation with chest pain, ST-segment elevation followed by T-wave inversion, myocardial enzymatic release, and left ventricular (LV) wall motion abnormalities (so-called apical ballooning) in the absence of significant coronary artery lesions on angiography. This syndrome usually affects postmenopausal women and is precipitated by physical stress, psychological triggers, or other states of adrenergic overstimulation such as administration of catecholamines, abrupt withdrawal of psychotropic drugs, and uncontrolled pain. Affected patients usually survive, showing restoration of previous cardiovascular status with electrocardiographic (ECG) normalization and recovery of ventricular function within approximately 1 month. Based on the regional distribution of LV dysfunction, the following variants of TTC have been described: 1 “typical” (akinesia of the mid-apical LV segments) and 3 “atypical,” that is, “mid-ventricular” (akinesia of the mid-LV segments), “reverse” (wall motion abnormalities confined to the basal/