Takotsubo cardiomyopathy

• the Tako-tsubo syndrome is characterized by acute chest pain accompanied by reversible apical ballooning in the absence of significant coronary artery disease
  • features include transient left ventricular (LV) dysfunction, electrocardiographic changes, and minimal myocardial enzymatic release mimicking acute myocardial infarction (MI) (1)
  • early left ventriculography revealed basal normokinesia and apical akinesia at the same time, and the end-systolic ventriculogram looked like a "tako-tsubo" used for trapping octopuses in Japan - thus the term "tako-tsubo-like LV dysfunction" was proposed in 1990 for this condition
  • the Tako-Tsubo syndrome has been widely recognized in Japan and a multicenter study (2) showed some of the clinical features, including a predominance of elderly women, as well as a favorable prognosis1) LV asynergy extended over more than one coronary artery region and was quite different from that in acute MI;2) this asynergy was localized to the apical region; and 3) this asynergy was dramatically resolved in a short time.
    • angiographic main findings were:
  • an episode of emotional or physiologic stress frequently precedes presentation with the syndrome (3)
    
    
  • in a prospective observational study (n=825) comparing all-cause death rates in patients discharged with or without beta-blockers it is reported that beta-blockers were associated with a lower risk of death after median 24 month follow up (HR 0.56 (95%CI: 0.36-0.89)) (4)

Note that little is known about its pathophysiology, partly because the condition was rare.

Click here for example ECGs and further information

Reference:

1. S. Kurisu, H. Sato, T. Kawagoe 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
2. K. Tsuchihashi, K. Ueshima, T. Uchida et al., Transient left ventricular apical ballooning without coronary artery stenosis: a novel heart syndrome mimicking acute myocardial infarction. J Am Coll Cardiol 2001; 38:11-18
3. Ann Intern Med. 2004;141(11):858-65
4. Silverio A, Parodi G, Scudiero F, et al. Beta-blockers are associated with better long-term survival in patients with Takotsubo syndrome.Heart Published Online First: 31 March 2022. doi: 10.1136/heartjnl-2021-320543