Abstract
Takotsubo cardiomyopathy (TTC), also known as broken heart syndrome, stress cardiomyopathy (SCM), or apical ballooning syndrome, is a non-ischemic cardiac disease with an initial clinical presentation that is very similar to acute coronary syndrome (ACS). Ventricular arrhythmias (VAs) contribute significantly to an increase in the rates of death in patients with TTC, especially during the acute phase, in which patients with TTC are more susceptible to develop life-threatening arrhythmias (LTA) such as ventricular tachycardia (VT), ventricular fibrillation (VF), torsades de pointes (TdP), and sudden cardiac death (SCD). However, the pathophysiology of TTC and how VA occurs are still a mystery. We aim to review previous literature and discuss the possible mechanisms of VA in TTC patients.VA usually complicates the acute phase of the disease and worsens the long-term prognosis. Alterations of repolarization (negative T wave, prolonged QTc) indicate a high risk of arrhythmic events (TdP, VT, VF, and SCD). Catecholamine effect on myocardial cells and myocardial edema can create a substrate for the development of VA. Some of the most commonly proposed mechanisms for the development of VA in patients with TTC are coronary vasospasm, myocardial stunning due to catecholamines, re-entry, and triggered activity. Further prospective studies, including a more significant number of patients, are required to understand the disease's pathophysiology better and improve LTA management in patients with TTC.
Highlights
BackgroundTakotsubo cardiomyopathy (TTC), known as broken heart syndrome, stress cardiomyopathy (SCM), or apical ballooning syndrome, is a type of non-ischemic cardiac disease characterized by an acute dysfunction of the myocardial tissue primarily affecting the left ventricle
Catecholamine effect on myocardial cells and myocardial edema can create a substrate for the development of Ventricular arrhythmias (VAs)
A wide variety of arrhythmias are associated with TTC; the list includes life-threatening arrhythmias (LTA) such as ventricular tachycardia (VT), ventricular fibrillation (VF), prolongation of the QT interval leading to torsades de pointes (TdP), and, in the worst-case scenario, sudden cardiac death (SCD) [10]
Summary
Takotsubo cardiomyopathy (TTC), known as broken heart syndrome, stress cardiomyopathy (SCM), or apical ballooning syndrome, is a type of non-ischemic cardiac disease characterized by an acute dysfunction of the myocardial tissue primarily affecting the left ventricle. ECG findings on admission showed QTc measuring 580 ms and a heart rate of 40 beats per minute; on day two, QTc increased to 720 ms, which led to developing TdP She was treated with DC cardioversion and magnesium sulfate and received a dual-chamber pacemaker. Rotondi et al studied a 65-year-old woman with syncope after emotional stress [19] Twenty-six hours after implantation, he developed QTc 539 ms with polymorphic VT, which resulted in VF requiring electrical shocks to terminate it Ten days later, his ECG returned to normal. Rey, and Dacher described a 34-year-old female with clinical symptoms of acute appendicitis She developed hemodynamic collapse due to VF after induction of anesthesia requiring electrical shocks to resolve. We observed prolongation of the QT in all the above patients; this carries a higher chance of presenting life-threatening ventricular arrhythmias, TdP and VF (Table 1)
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