Takotsubo Cardiomyopathy: Pathophysiology and Assessment

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Takotsubo Cardiomyopathy: Pathophysiology and Assessment

Roberto M Lang, MD

Tako-Tsubo Cardiomyopathy

Broken Heart Syndrome

Apical Balooning

1. Sato H, Tateishi H, Uchida T, et al. Takotsubo type cardiomyopathy due to multivessel spasm. In: Kodama K, Haze, K, Hon M, editors. Clinical aspect of myocardial injury: from ischemia to heart failure. Kagaku Hyoronsha; Tokyo: 1990 pp. 56-64 [in Japanese]

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Risk Factors A significant emotional or physical stressor or neurologic injury typically precedes the development of the TCM.(4) Stressors include the following: ? Learning of a death of a loved one ? Bad financial news ? Legal problems ? Natural disasters ? Motor vehicle collisions ? Exacerbation of a chronic medical illness ? Newly diagnosed, significant medical

condition ? Surgery ? Intensive care unit (ICU) stay ? Use of or withdrawal from illicit drugs ? Near drowning episodes

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Diagnostic Criteria 4

New ECG abnormalities

Absence of obstructive coronary artery disease

Transient LV apical akinesis/dyskinesis

*Without concurrent conditions; head injury/intracranial bleed/pheochromocytoma/myocarditis/hypertrophic cardiomyopathy

Diagnostic Criteria

? Transient hypokineses, dykinesis, or akinesis of the LV midsegments, with or without apical involvement; the regional wall-motion abnormalities extend beyond a single epicardial vascular distribution, and a stressful trigger is often, but not always, present

? Absence of obstructive coronary disease or angiographic evidence of acute plaque rupture

? New ECG abnormalities (either ST-segment elevation and/or T-wave inversion) or modest elevation in the cardiac troponin level

? Absence of pheochromocytoma or myocarditis (5)

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Takotsubo

Microvascular dysfunction

*Estrogen deficiency

Coronary artery

Microspasm

Excess plasma

women

catecholamines

Myocardial stunning Acute sympathetic overactivity

Increased sensitivity in post-menopausal

Patient History

?70 yo AAF admitted with chest pain with a small enzyme leak ?No significant PMH ?Similar complaints at an outside hospital 2 days PTA

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Patient History

?At the time of admission:

?BP 95/59, P 69, RR 16, P Ox 100% ? MB index 5.8 ? Troponin 0.45

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Classic ECG features

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Classic ECG features

6 hr 3 D 20 D

6 hr 3 D 20 D

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Initial ECG

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Follow-up ECG

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LV Function & MCE

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Low MI Triggered MCE

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Base 3D MCE

Mid Apex

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