The Other Great Masquerader: Takotsubo Cardiomyopathy

Dr. Deepak Bhosle, Adukia S, Patil R, Chavan C

Dr. Deepak Bhosle, Adukia S, Patil R, Chavan C

Keywords: Reversible cardiomyopathy, Mayo criteria for takotsubo cardiomyopathy, Catecholamine induced ventricular dysfunction

Abstract

Takotsubo cardiomyopathy is a rare entity that mimics acute myocardial infarction or congestive heart failure. It is characterised by acute, transient, reversible left ventricular dysfunction that can mimic an acute coronary event at presentation. Coronary arteries are however, often normal on cardiac catheterisation. Patients are usually postmenopausal women who experience acute physical or emotional distress. For years this syndrome has been mistaken for acute myocardial infarction owing to a typical presentation with chest pain, electrocardiographic abnormalities, elevated cardiac enzymes and focal left ventricular wall motion abnormalities. Clinical diagnosis is difficult and demands a high index of suspicion. Recently proposed Mayo criteria might help in diagnosis. Delay in diagnosis should not result in delay in treatment. We report a case involving a post menopausal female who had an attack of takotsubo cardiomyopathy with a favourable outcome.

References

1. Aurigemma GP. Acute Stress Cardiomyopathy and Reversible Left Ventricular Dysfunction-Cardiology rounds. 2006 December; 10(10).
2. Seow SC, Lee YP, Tao S, et al. Takotsubo cardiomyopathy associated with status epilepticus. Eur J Neurol. 2008 June;15(6): e46
3. Richard C. Stress-related cardiomyopathies. Annals of Intensive Care. 2011;1:39
4. Seth PS, Aurigemma GP, Krasnow JM, Tighe DA, Untereker WJ, Meyer TE. Asyndrome of transient left ventricular apical wall motion abnormality in the absence of coronary
disease: a perspective from the United States. Cardiology. 2003;100:61-66.
5. Bybee KA, Kara T, Prasad A, et al. Systemic Review: Transient left ventricular apical ballooning: A syndrome that mimics ST-segment elevation myocardial infarction. Ann Intern Med. 2004;141:858-865
6. Kurisu S, Sato KT, Ishihara M, et al. Tako-tsubo–like left ventricular dysfunction with ST segment elevation: a novel cardiac syndrome mimicking acute myocardial infarction. Am Heart J. 2002;143:448-455.
7. Kurisu S, Inoue I, Kawagoe T, et al. Myocardial perfusion and fatty acid metabolism in patients with tako-tsubo-like left ventricular dysfunction. J Am Coll Cardiol. 2003;41(5): 743-8.
8. Bybee KA, Prasad A, Barsness GW, et al. Clinical characteristics and thrombolysis in myocardial infarction frame counts in women with transient left ventricular apical ballooning syndrome. Am J Cardiol. 2004;94:343-6.
9. Ako J, Sudhir K, Farouque HM, Honda Y, Fitzgerald PJ. Transient left ventricular dysfunction under severe stress: brain-heart relationship revisited. Am J Med. 2006; 199(1):10-17.
10. Kono T, Morita H, Kuroiwa T, Onaka H, Takatsuka H, Fujiwara A. Left ventricular wall motion abnormalities in patients with subarachnoid hemorrhage: neurogenic stunned myocardium. J Am Coll Cardiol 1994;24:636-40.
11. Antonio D’Aloia, Claudia Fiorina, Enrico Vizzardi, Pompilio Faggiano, Livio Dei Cas. Hypertensive crisis and acute, reversible, left ventricular systolic dysfunction: a case report. The European Journal of Heart Failure. 2002;655–660.