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  • TAKOTSUBO HEART
    Takotsubo Heart – aka Broken heart Syndrome – A transient apical dyssynergy due to extreme emotional and or physical stress
    Ashley Davidoff MD
  • Takotsubo Cardiomyopathy (etym Japanese Octopus Trap (aka Transient apical ballooning syndrome, apical ballooning cardiomyopathy, stress-induced cardiomyopathy, Gebrochenes-Herz-Syndrom, broken-heart syndrome
  • is a
      • sudden , transient regional systolic functional abnormality of the heart that mimics AMI
  • Caused by
      • severe emotional distress and thus sudden massive surge of catecholamines such as adrenaline and norepinephrine
      • Theories
        • vasoconstriction  resulting in transient ischemia
        • microvascular dysfunction
        • midventricular obstruction with apical stunning
        • catecholamine-induced myocyte injury
      • Pheochromocytoma
  • Resulting in weakening and malfunction
    • Clinical
      • Often post menopausal women
      • Most common presenting symptom is
        • acute substernal chest pain,
        • some have dyspnea
          • Other
            • CHF
            • tachyarrhythmias
            • cardiogenic shock 10%
    • Acute Coronary Syndrome
      • EKG
        • S-T segment elevation
      • Lab
        • Troponin elevated in most patients
  • EchoCath
    • Neg coronaries
    • LV gram
      • base of the left ventricle is contracting normally or is hyperkinetic while the remainder of the left ventricle is akinetic or dyskinetic.
      • May have midsystolic LVOT obstruction with mitral regurgitation
  • Pathology
    • consistent with catecholamine toxicity with
      • interstitial fibrosis
      • cellular infiltration
      •  no evidence of myocarditis
Complications
    • acute congestive heart failure,
    • lethal abnormal heart rhythms,
    • rupture of the heart wall.
    • Death 1.8%
  • Natural History
  • Most of the abnormalities in systolic function resolve in
    • one to four weeks, and
      • recover
        • within two months.

 

 Images
TAKOTSUBO CARDIOMYOPATHY NORMAL CORONARIES
74-year-old male with type 2 diabetes, CAD s/p stent 6 years prior, hypertension and hypercholesterolemia, fell at home and presents to the ER.

TAKOTSUBO CARDIOMYOPATHY – NORMAL CORONARIES

 

TAKOTSUBO HEART
Left ventriculography during systole showing apical ballooning akinesis with basal hyperkinesis in a characteristic takotsubo ventricle
Wikipedia Courtesy Tara C Gangadhar, Elisabeth Von der Lohe, Stephen G Sawada and Paul R Helft
TAKOTSUBO HEART
Left ventriculogram during systole displaying the characteristic apical ballooning with apical motionlessness in a patient with takotsubo cardiomyopathy
Courtesy Olagoke Akinwande, Yasmin Hamirani and Ashok Chopra
TAKOTSUBO HEART
Ashley Davidoff MD

 

 

From Wikipedia

The Japanese octopus traps after which this disease is named
Courtesy Wiki Commons

References and Links

Wiki
Radiopaedia

Ramaraj R, et al . Levels of troponin release can aid in the early exclusion of stress-induced (takotsubo) cardiomyopathy. Exp Clin Cardiol. 2009 Spring;14(1):6-8. PMID: 19492036; PMCID: PMC2689087.