TakoTsubo cardiomyopathy: unravelling the malignant consequences of a benign disease with cardiac magnetic resonance

Abstract

TakoTsubo cardiomyopathy (TCM) is a unique type of reversible cardiomyopathy that is precipitated by a stressful emotional or physical event. The increasing incidence is due to the greater use of emergency coronary angiography, newer cardiac biomarkers together with more sensitive cardiac imaging techniques. Few case reports have documented how TCM can present with malignant arrhythmias such as torsades de pointes caused by the repolarisation abnormalities or QTc prolongation. Although TCM is usually considered a benign reversible condition, its associated arrhythmic risk is increasingly recognised. TCM often presents as an acute coronary syndrome with unobstructed coronary arteries at angiography. In this patient population, cardiac magnetic resonance (CMR) is a useful tool to establish a differential diagnosis, discriminating TCM from acute myocarditis and myocardial infarction with spontaneous recanalisation. CMR is becoming a promising new diagnostic modality in risk stratifying patients with potential higher arrhythmic risk.

Fig. 1

a Defibrillator monitor showing polymorphic VT and b 12 lead ECG showing sinus rhythm with markedly prolonged QTc

Fig. 2

a TCM presenting with narrow complex tachycardia (likely fascicular VT), and b Defibrillator monitor showing lack of response to DC cardioversion

Fig. 3

a Four-chamber view showing mid-apical oedema in T2-weighted sequences and b no evidence of significant late gadolinium enhancement in T1-weighted inversion recovery post-contrast sequences