Takotsubo Cardiomyopathy-the Broken Heart Syndrome, an Indian Perspective

Abstract

Background: Takotsubo Cardiomyopathy (TTC) is a reversible cardiomyopathy which is precipitated by adrenergic stress. Trigerring factors, clinical features and mortality data from Indian subcontinent is absent. Aims: The present study was undertaken to determine the clinical features, type of emotional stress, mode of presentation, duration of improvement, cardiogenic shock, in hospital mortality,and the treatment given to the patients. Methodology: This is a single centre retrospective study,done on patients who presented with ACS and 2D Echocardiography showing Regional Wall Motion Abnormality (RWMA) from 2010 to 2015. The confirmation of TTC was based on 2D Echo findings and coronary angio graphy(CAG). Statistical analysis used- Chi square test was used to compare the categorical variables between different stresses. Fisher exact test was also used to compare the categorical variables. We used independent t test to compare the mean of the ejection fraction between 2 groups. Results: Among 43 patients with TTC, most were females, between age group 51 to 80 yrs (77%). Most patients were found to have stress, in form of medical stress(35%), emotional stress(33%) with equal percentage. Some patients had surgical stress(21%) and some patients(11%) did not have any stress at all. In the present study 56 % had hypertension (HTN), 44% had Diabetes Mellitus (DM), and 9% had dyslipidemia (DLP). ECG showed T wave inversion(54%), ST elevation(49%), Q wave(9%), ST depression(7%) and no ST-T changes(5%). Initial Echo showed Ejection Fraction (EF) ≤ 35% in 46.5 %, 36 – 45% in 46.5 % and 46–55% in 7 %. Cardiogenic shock (18.6%) occurred frequently in surgical group and associated with high mortality. In our study EF improved in most of the patients(86%) within 1 month of follow up. Conclusions: TTC, predominantly involves females and is precipitated by medical illness or emotional stress in most of the patients. Recovery of left ventricular function is complete in all patients and prognosis is good. But when it occurs in patients following major non cardiac surgery, there can be significant mortality and morbidity. Key words: Transient Apical Balooning, Stress Cardiomyopaty.