Scintigraphic Evaluation of Takotsubo Cardiomyopathy

Abstract

The Takotsubo Cardiomyopathy (TC) also called broken heart syndrome, or stress-induced cardiomyopathy is characterized by the transient ballooning of the apex during systole as result of apical dyskinesia in conjunction with a compensatory hyperkinesia of the base of the left ventricle; in the absence of significant epicardial coronary artery dis- ease. We report a case of TC with the characteristic findings of apical dyskinesia and perfusion abnormalities on gated SPECT which was diagnosed in retrospect after coronary angiography and left ventriculography. This is followed by a brief review of the scintigraphic techniques that have been used in the evaluation of TC. As TC accounts for at least 1-2% of presentations of acute coronary syndromes, increased awareness on the part of interpreting physicians is required for earlier diagnosis in the subset of patients referred for myocardial perfusion imaging. TC can present with symptoms similar to CAD (Chest pain, shortness of breath, etc) in the presence of ECG changes and mild elevation of cardiac enzymes. It seems to be more frequent in women of post menopausal age (2) but the exact prevalence is unknown. Akashi and colleagues found that the prevalence of TC in their institution was around 2% (3) similar to what Bybee and co-workers re- ported (4). New cases of TC are reported every year around the world and nuclear medicine techniques have been used in evaluation of several of these cases. We present the follow- ing case in which gated SPECT contributed significantly to diagnosis followed by a brief review of the different scinti- graphic techniques that have been used in the evaluation of