Takotsubo Cardiomyopathy

Takotsubo cardiomyopathy (TC), also known as stress cardiomyopathy and broken-heart syndrome, is a rare, reversible cardiomyopathy that is seen in conditions of extreme emotion or medical stress. It is characteristically seen in elderly or postmenopausal women and can mimic acute coronary artery syndrome.

There is reversible left akinesis of the apical and distal anterior wall together with hypercontraction of the basal wall in the absence of angiographically significant coronary artery narrowing. The shape of the heart apparently resembles that of a "takotsubo," a Japanese pot used in trapping octopus. How much pot one has to smoke for this resemblance to appear is currently unknown, but under intense investigation.

It is thought that the apex is disproportionately vulnerable due to any or all of the following:

• Lack of a 3-layered myocardial configuration
• Limited elasticity reserve
• Relatively limited coronary circulation
• Increased responsivity to adrenergic stimulation

Cardiac MRI has been used to evaluate these patients. T2-weighted sequences have shown edema in the majority of patients in the acute setting. At least one group found a statistically significant relationship between the amount of edema and the severity of regional systolic dysfunction. Delayed gadolinium enhancement is not typically seen in the acute setting; however, there are reports of minute foci of delayed enhancement in a minority of cases, and presence of delayed enhancement should not exclude TC. Apical thrombi have also been reported in a minority of cases (either by MRI or echocardiography).

References

• Virani SS, et al. Takotsubo Cardiomyopathy, or Broken-Heart Syndrome. Tex Heart Inst J. 2007; 34(1): 76–79.
• Leurent G, Larralde A, Boulmier D, Fougerou C, Langella B, Ollivier R, Bedossa M, Le Breton H. Cardiac MRI studies of transient left ventricular apical ballooning syndrome (takotsubo cardiomyopathy): a systematic review. Int J Cardiol. 2009 Jun 26;135(2):146-9.