Takotsubo cardiomyopathy--a clinical review

Abstract

Stress cardiomyopathy is characterised by reversible left ventricular dysfunction. It simulates an acute coronary syndrome (ACS), presenting with precordial pain or dyspnoea, changes of the ST segment, T wave, or QTc interval on electrocardiogram, and raised cardiac enzymes. Typical findings are disturbances of segmental contractility (apical hypokinesia or akinesia), with normal epicardial coronary arteries. The true prevalence is unknown, as the syndrome may be under-diagnosed; it is more common in postmenopausal women. There is usually a trigger in the form of physical or psychological stress. The electrocardiographic, echocardiographic, and ventriculographic changes resolve spontaneously over a variable period of time (from days to months). There are a number of pathophysiological theories, none of which has been shown to be definitive, suggesting that all of them may be involved to some extent. The prognosis is generally favourable, and recurrence is very rare.

Figure 1

Echocardiographic image in apical ballooning which is also observed mitral prolapse (P2).

Figure 2

This is hybrid speckle tracking imagen of takotsubo patient. There is a pathological displacement curve in the apical segments and increased in the basal segments.

Figure 3

Ventriculography image of apical ballooning which shows apical akinesia and basal hyperkinesis.