Was later described elsewhere as well and is being increasingly recognized. It can be diagnosed in several ways, including one or more. Takotsubo cardiomyopathy brokenheart syndrome harvard. Overview left ventricular apical akinesis octopus trap mimics acute coronary syndrome st elevation elevated troponin no coronary stenosis unknown etiology. A pathophysiologic study of takotsubo cardiomyopathy with f18 fluorodeoxyglucose positron emission tomography. Hyponatremia an unusual trigger of takotsubo cardiomyopathy. Takotsubo cardiomyopathy is rapidly reversible heart failure syndrome that usually mimics the symptoms of acute.
Takotsubo cardiomyopathy tc or syndrome was first described more than 2 decades ago by dote and colleagues in japan, but has since been increasingly recognised around the world. To earn cme for this chapter, you need to subscribe. Patients typically present with chest pain, electrocardiographic changes consistent with acute ischemia or infarct, and elevated cardiac enzymes in the. Takotsubo cardiomyopathy brokenheart or stressinduced cardiomyopathy. Overview left ventricular apical akinesis octopus trap mimics acute coronary syndrome st elevation elevated troponin no coronary stenosis unknown etiology triggered by emotional stressor 3. The condition mimics a heart attack and is typically brought about by stress and emotional disturbance in an individuals life. Dec 16, 2008 the prognosis of patients with takotsubo cardiomyopathy is generally favorable. Stress cardiomyopathy is an acute reversible heart failure syndrome initially believed to represent a benign condition due to its selflimiting clinical course, but now recognized to be associated with a nonnegligible rate of serious complications such as ventricular arrhythmias, systemic thromboembolism, and cardiogenic shock. Psychiatric illness in takotsubo stress cardiomyopathy. In takotsubo cardiomyopathy also called transient apical ballooning and stress cardiomyopathy, left ventricular dysfunction, which can be remarkably depressed, recovers within a. Takotsubo cardiomyopathy was named after the shape of an ancient japanese octopus trap, but is also known as stress or stressinduced cardiomyopathy sc, transient apical ballooning syndrome or cardiomyopathy. To date, early cardiac catheterization is the only definite way to distinguish between acute coronary syndrome and takotsubo.
Iatrogenic epinephrineinduced takotsubo cardiomyopathy in. This transient cardiac dysfunction may affect women of childbearing age in the antepartum, intrapartum or postpartum period. Results takotsubo cardiomyopathy is typically characterized by the following. Although associated with increased levels of catecholamines, pathophysiological mechanisms are unknown. Her electrocardiogram was suggestive of myocardial ischemia and her troponin levels were elevated. Although there is an apparent rapid and spontaneous recovery of left ventricular ejection fraction, the longterm clinical and functional consequences of takotsubo cardiomyopathy are illdefined. Clinical features and outcomes of takotsubo stress. The case for takotsubo cardiomyopathy syndrome as a. Takotsubo cardiomyopathy brokenheart syndrome harvard health. Recurrence of takotsubo cardiomyopathy is a wellknown reported longterm issue in the takotsubo cohort. A consensus document article pdf available in giornale italiano di cardiologia 2006 911.
This weakening may be triggered by emotional stress, such as the death of a loved one, a breakup, rejection from a partner or constant anxiety. However, sinus node dysfunction is relatively infrequent in the setting of takotsubo cardiomyopathy. Takotsubo cardiomyopathy tts, also known as stress cardiomyopathy, is a type of non ischemic cardiomyopathy in which there is a sudden temporary weakening of the muscular portion of the heart. Stressrelated cardiomyopathy such as takotsubo cardiomyopathy occurs primarily in postmenopausal women. Tc is seen almost exclusively in postmenopausal women following extreme emotional or physiologic stress.
Ppt takotsubo cardiomyopathy powerpoint presentation free. Cardiac function usually recovers spontaneously in most patients within days or weeks 4, 5. Risk factors and management of takotsubo cardiomyopathy. Chemotherapyinduced takotsubo cardiomyopathy, a case. Takotsubo cardiomyopathy is a transient left ventricular dysfunction with wallmotion abnormalities which mimics myocardial infarction without acute coronary disease.
Chemotherapyinduced takotsubo cardiomyopathy, a case report. Until 2000, a few case reports were published, but the. Its diagnosis continues to be controversial 18 table 1. We are reporting a case of a 73yearold woman with a history of asymptomatic sinus bradycardia who developed sick. Takotsubo cardiomyopathy tc is an acute cardiac syndrome, which presents like acs misdiagnosis poses a bleeding risk to the patient through thrombolysis awareness of tc and the at risk demographic is therefore vital clinicians should include tc in their differential. We, hereby, present a case of a patient having three. Stress cardiomyopathy also called apical ballooning syndrome, takotsubo cardiomyopathy, broken heart syndrome, and stressinduced cardiomyopathy is a syndrome characterized by transient regional systolic dysfunction of the left ventricle lv, mimicking myocardial infarction, but in the absence of angiographic evidence of obstructive coronary artery disease or acute plaque. The prognosis of patients with takotsubo cardiomyopathy is generally favorable. Takotsubo is a type of cardiomyopathy a disease of the heart muscle. Ppt takotsubo cardiomyopathy powerpoint presentation.
Takotsubo cardiomyopathy is an important differential diagnosis of acute coronary syndrome. Named after the takotsubo, which is an octopus trap. Jul 31, 2019 takotsubo cardiomyopathy tcm is a transient cardiac syndrome that involves left ventricular apical akinesis and mimics acute coronary syndrome. Takotsubo cardiomyopathy an overview sciencedirect topics. A 61yrold female was undergoing semiurgent ureteral stenting under general anaesthesia after the diagnosis of a right upper urinary tract dilatation associated with delayed secretion of contrast dye, 5 days after uneventful. Takotsubo cardiomyopathy is characterized by transient left ventricular apical ballooning, which results in temporary left ventricular dysfunction. For additional examples, see stressors associated with takotsubo. Takotsubo cardiomyopathy tc also known as transient apical ballooning or stress cardiomyopathy is a reversible clinical entity characterized by transient cardiac apical ballooning 1. Takotsubo cardiomyopathy has recently been recognized in patients with typical signs of acute myocardial infarction mostly due to emotional stress 4. Variants of the classical left ventricular apical ballooning, including mid or basal left ventricular wall motion. The initial case of tcm reported in the setting of aaw involved a 64yearold man with alcohol dependence admitted with hypokalemiarelated cardiomyopathy. It was first described in japan in 1990 by sato et al. Stress cardiomyopathy, or takotsubo syndrome, is a transient and reversible disorder that occurs suddenly after emotional or physical stress.
In takotsubo cardiomyopathy also called transient apical ballooning and stress. This registry data should lead to a better understanding of this emerging disease entity which mimics myocardial infarction and to improve disease managment and outcome. Information on takotsubo cardiomyopathy or broken heart syndrome including symptoms diagnosis and treatment. Takotsubo cardiomyopathystressinduced cardiomyopathy 2. The most widely accepted diagnostic criteria are those of the mayo clinic, which requires normality of the. Aug 27, 2010 stress cardiomyopathy or takotsubo syndrome ts is an acute, reversible disorder of the heart characterised by left ventricular dysfunction. Cureus risk factors and management of takotsubo cardiomyopathy. Mechanisms of stress takotsubo cardiomyopathy nature. Takotsubo cardiomyopathy tcm also known as stress induced cardiomyopathy is characterized by new onset left ventricular dysfunction with variable wall motion abnormalities in the absence of significant coronary artery disease 1,2,3. Cancer is a chronic condition that induces significant emotional and physical stress, which may increase the risk for developing takotsubo cardiomyopathy tcm.
Stress takotsubo cardiomyopathya novel pathophysiological. Takotsubo cardiomyopathy is an increasingly recognized acute heart failure syndrome precipitated by intense emotional stress. Takotsubo cardiomyopathy tcm is a temporary and reversible heart condition. The takotsubo registry is an international, observational registry in patients with takotsubo cardiomyopathy. Takotsubo cardiomyopathy is associated with increased risk of ventricular arrhythmias, atrial fibrillation, and bradyarrhythmias. These prevalences were comparable to those described in the literature regarding takotsubo cardiomyopathy ttc 8,10, 11, 23,24,25 and ppg. Lack of genetic susceptibility in takotsubo cardiomyopathy. Takotsubo cardiomyopathy is a condition which affects the heart muscle, giving the left ventricle a distinctive shape. Takotsubo cardiomyopathy is a temporary heart condition that develops in response to an intense emotional or physical experience. Management of arrhythmias in patients with takotsubo cardiomyopathy. Figure 1 download figure open in new tab download powerpoint.
We present a case of a multifactor induced takotsubo cardiomyopathy in a young 18yearold man. It is thought to be brought on by extremely stressful events, and affects how the heart works. Booklet about the emotional impact of living with cardiomyopathy. Hypertrophic cardiomyopathy hcm is an autosomal dominant heart. Stress cardiomyopathy diagnosis and treatment jacc. The case for takotsubo cardiomyopathy syndrome as a variant.
Takotsubo cardiomyopathy or takotsubo syndrome tts, also known as stress cardiomyopathy, is a type of nonischemic cardiomyopathy in which there is a sudden temporary weakening of the muscular portion of the heart. Several chemotherapy molecules, monoclonal antibodies and tyrosine kinase inhibitors, have been linked to takotsubo cardiomyopathy tc. Takotsubo cardiomyopathy probably accounts for 12% of all cases of suspected acute myocardial infarction, its true prevalence is unknown because of under diagnosis. Takotsubo cardiomyopathy tc, also known as stressinduced cardiomyopathy, apical ballooning syndrome, and broken heart syndrome, is an increasingly diagnosed condition.
We believe that the published inhospital mortality. February 2020 takotsubo cardiomyopathy dont go breaking. Computerassisted scopus or medline searches of the literature for the terms apical ballooning, ampulla cardiomyopathy, takotsubo cardiomyopathy, and takotsubo cardiomyopathy between 1989 and december 2007 demonstrated an exponentially increasing frequency of publications. Takotsubo cardiomyopathy in the setting of acute alcohol. Four other cases of tcm occurring in the setting of aaw were identified. Epinephrineinduced takotsubo cardiomyopathy federal. Sign up today for full access to all episodes and earn cme. A 61yrold female was undergoing semiurgent ureteral stenting under general anaesthesia after the diagnosis of a right upper urinary tract dilatation associated with delayed secretion of contrast dye, 5 days after uneventful laparoscopic removal of bilateral benign. Its also known as stress cardiomyopathy or broken heart syndrome.
Takotsubo stress cardiomyopathy broken heart syndrome. Mar 12, 2019 takotsubo cardiomyopathy is rare in pregnancy and is characterized by left ventricular dysfunction with apical ballooning. In takotsubo cardiomyopathy also called transient apical ballooning and stress cardiomyopathy, left ventricular dysfunction, which can be remarkably depressed, recovers within a few weeks. Of 1750 patients with takotsubo cardiomyopathy, 89. This ecg demonstrates resolution of the stsegment elevation, and now shows diffuse twave inversion and poor rwave progression. The ability to rapidly perform bedside echocardiography with echodoppler imaging places this modality in the heart of clinical. Most patients respond well to medical management with resolution of cardiac dysfunction within weeks. Apical ballooning syndrome or takotsubo cardiomyopathy. Takotsubo cardiomyopathy, also known as transient left ventricular apical ballooning, stress cardiomyopathy, and broken heart syndrome, is a condition that mimics acute myocardial infarction. Takotsubo cardiomyopathy is a weakening of the left ventricle, the hearts main pumping chamber, usually as the result of severe emotional or physical stress, such as a sudden illness, the loss of a loved one, a serious accident, or a natural disaster such as an earthquake. Uncertainty about the mechanism of takotsubo events is reflected in diverse classifications for this entity, considered a cardiomyopathy in the united states and an acute heart failure syndrome in europe. Variants of the classical left ventricular apical ballooning, including mid or basal left. Over the past years, echocardiography has been shown to play a pivotal role in the accurate evaluation of left ventricular function particularly in patients with ischemic heart disease and various manifestations of cardiomyopathy.
For example, in 2000, only 2 publications were recorded, compared with nearly 300 in 2010. Electrocardiogram ecg from the same patient discussed in the previous ecg, obtained several days after the initial presentation. Stress cardiomyopathy or takotsubo syndrome ts is an acute, reversible disorder of the heart characterised by left ventricular dysfunction. Shape of the trap is similar to the appearance of lv apical ballooning noted in patients with this form of cardiomyopathy. Emotional triggers were not as common as physical triggers 27. Takotsubo cardiomyopathy journal of hospital medicine. We present a case of a 62yearold female who presented with chest pain and shortness of breath. Takotsubo cardiomyopathy in a cardiology department revista. Given the findings in the animal model, treatment with a combined. Takotsubo cardiomyopathy mimics acute myocardial infarction in its presentation and has a recognized recurrence rate. Takotsubo cardiomyopathy in a patient with preexisting.
In this condition, the hearts main pumping chamber changes shape, affecting the hearts ability to pump blood effectively. The mainstay of treatment initially is supportive care with beta. Takotsubo cardiomyopathy in cancer patients cardio. Takotsubo cardiomyopathy tcm, also known as stressinduced cardiomyopathy, is a cardiomyopathy characterized by acute reversible apical ventricular dysfunction and apical akinesis in the absence of obstructive coronary artery disease. Physiopathology of this entity remains unclear and different hypotheses are given. This registry data should lead to a better understanding of this emerging disease entity which mimics myocardial infarction and. Takotsubo cardiomyopathy also known as transient apical ballooning, stressinduced cardiomyopathy, and simply stress cardiomyopathyis a nonischemic cardiomyopathy in which there is sudden temporary lv systolic dysfunction. Takotsubo cardiomyopathy tcm, also known as broken heart syndrome, is a type of heart failure characterized by transient ventricular dysfunction in the absence of obstructive coronary lesions. The pathophysiological aspects of the disease are still a matter of debate and a standard treatment consensus is lacking. Abstract takotsubo cardiomyopathy tc, or broken heart syndrome, is an increasingly recognized condition that mimics acute myocardial infarction with morphologically characteristic left ventricular dysfunction in the absence of coronary artery disease.
T akotsubo cardiomyopathy tcm is a transient left ventricular lv wall motion abnormality often associated with acute medical illnesses, catastrophic life events, and intense physical or emotional stress. Initial recognition of takotsubo cardiomyopathy occurred in japan in 1990, with the first report emerging from the united states in 1998. Takotsubo cardiomyopathy is a recognised form of transient left ventricular dysfunction that is presumably caused by emotional, physical or medical stress. Cardiac catheterization showed mild coronary artery. Thereafter, scientific interest in this condition has increased steadily and dramatically. It constitutes an important differential diagnosis from acute myocardial infarction mi and probably accounts for 12% of all cases of suspected mi 2. Download pdf versions of our information resources. Apr 14, 2010 for instance, widespread use of echocardiography has contributed to more frequent recognition of takotsubo stress cardiomyopathy. Persistent longterm structural, functional, and metabolic. Pdf on sep 1, 2010, spyridon koulouris and others published takotsubo. Editorwe report a case of a takotsubo cardiomyopathy just before induction of general anaesthesia for a semiurgent surgery. Takotsubo cardiomyopathy tc, also known as transient left ventricular apical.
Takotsubo cardiomyopathy tc is an acute cardiac syndrome, which presents like acs misdiagnosis poses a bleeding risk to the patient through thrombolysis awareness of tc and the at risk demographic is therefore vital clinicians should include tc in their differential diagnosis in cases of acs. Takotsubo cardiomyopathy, also known as stress cardiomyopathy, is a clinical syndrome that generally presents as chest pain mimicking acute coronary syndrome or as an acute heart failure. Takotsubo cardiomyopathy tcm is a condition characterized by. It is characterized by normal or nearnormal coronary arteries, regional wall motion abnormalities that extend beyond a single coronary vascular bed, and often, a precipitating stressor.
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