TAKO-TSUBO CARDIOMYOPATHY
TAKO-TSUBO CARDIOMYOPATHY
S. Koulouris
Evangelismos Hospital, Athens, Greece
Tako-tsubo cardiomyopathy (TTC) mimics acute coronary syndrome and is associated with reversible left ventricular apical ballooning in the absence of angiographically significant coronary artery stenosis. Since it is almost exclusively precipitated by acute emotional stress, the syndrome is also called “stress cardiomyopathy” or “broken-heart” syndrome. The incidence in unknown but may account for 1-2% of patient who present with the clinical picture of acute myocardial infarction. The majority of the patients are postmenopausal women and they usually present with chest pain. A unique feature of TTC is the occurrence of proceeding emotionally or physically sressful event in approximately two thirds of the patients. ST-segment elevation or depression and QT prolongaton are the most frequent EKG findings. Patients show an increase in cardiac troponins and the transthoracic echocardiogram can detect the regional wall-motion abnormality, but the diagnosis is frequently made in the cardiac catheterization laboratory. The patients typically do not have obstructive coronary artery disease and the left ventriculogram shows the characteristic ballooning of the mid and apical segments. Patients with TTC have a good prognosis and they usually experience complete resolution of regional wall-motion abnormalities within days or weeks. Athough the exact pathogenesis of TTC remains unclear various mechanisms have been proposed including vasospasm in epicardial coronary arteries, microvascular spasm, catecholamine-induced myocardial stunning and myocarditis. TTC has important implications, because its clinical presentation mimics that of an acute coronary syndrome. Prospective studies are needed to ascertain the long-term outcome and to elucidate the specific pathophysiologic mechanisms responsible for this cardiomyopathy.
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