Abstract
Takotsubo cardiomyopathy (TTC) is a clinical condition of transient acute heart failure correlated to regional wall motion abnormalities extending beyond the distribution of a single epicardial coronary artery. It is classified into four major types: apical, basal, mid-ventricular and focal. Sympathetic nerve stimulation and catecholamine storm are the main players in the pathogenesis of TTC. The clinical course of disease is generally benign but it may end with life-threatening complications. Coronary angiography, left ventriculogram, transthoracic echocardiography and cardiac magnetic resonance imaging (CMR) are the main tools for making diagnosis. Except for critical cases with hemodynamic instability and/or complications, the overall management is limited to conventional heart failure therapy.
Highlights
Takotsubo cardiomyopathy (TTC) known as « broken heart syndrome », « stress-induced cardiomyopathy » and « apical ballooning syndrome » is a clinical entity characterized by transient wall motion abnormalities of the left ventricle causing acute reversible heart failure that is not linked to obstructive coronary artery disease [1]
The hypothesis behind female preponderance was that men are more protected against cardiac adverse effects of catecholamines as they are more frequently exposed to physical stress [14]
A markedly elevated level of brain natriuretic peptides (BNP) is usually observed in most TTC patients. The rational for this finding extends from the knowledge of the pathophysiology of this cardiomyopathy characterized by regional wall motion abnormalities
Summary
Takotsubo cardiomyopathy (TTC) known as « broken heart syndrome », « stress-induced cardiomyopathy » and « apical ballooning syndrome » is a clinical entity characterized by transient wall motion abnormalities of the left ventricle causing acute reversible heart failure that is not linked to obstructive coronary artery disease [1]. The observed EKG abnormalities include ST-segment elevation in the anterior leads, ST-depression, Twave inversion, prolonged QT-interval, ventricular tachychardia and fibrillation [5], thereby causing misdiagnosis of TTC as ACS especially when these changes are associated with positive cardiac troponin level. This overlap in clinical presentation emphasizes on the importance of early coronary angiography according to the clinical setting for differential diagnosis. We briefly review the different types, pathophysiology and treatment of TTC
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