Takotsubo or Stress Cardiomyopathy

Many case reports have been published of reversible left ventricular dysfunction precipitated by sudden emotional stress. We have evaluated 10 women hospitalized for acute chest pain and dyspnea, mimicking an acute coronary syndrome, after a severe emotional trigger. Those patients, postmenopausal women, presented ST segment alterations on the EKG, minor elevations of cardiac enzymes, and biomarkers levels. At the coronarography there was not coronary thrombosis or severe stenosis, but the ventriculography showed wall motion abnormalities involving the left ventricular apex and midventricle, in the absence of significant obstructive coronary disease. The course was benign without complication, with a full recovery of left ventricular function in some weeks. These observations, like other reports, demonstrate the impact of emotional stress on left ventricular function and the risk of cardiovascular disease. The cause of this cardiomyopathy is still unknown, and several mechanisms have been proposed: catecholamine myocardial damage, microvascular spasm, or neural mediated myocardial stunning. 1. Introduction Broken heart syndrome or transient stress induced cardiomyopathy is characterized by left reversible systolic dysfunction which appears to be triggered by an intense psychologic stress in the absence of myocardial infarction. The syndrome is also known under several names, including “Ampulla cardiomyopathy, Takotsubo cardiomyopathy, Left Apical Ballooning Syndrome.” First reported by SATO et al. in the Japanese population in 1980, Takotsubo is a pot with a round bottom and a narrow neck used for trapping octopuses in Japan [1]. Today, many cases have been described worldwide, indicating that is extremely unlikely to be a geographically isolated disease. Owing to its clinical and imaging characteristics mimicking an acute coronary syndrome, apical ballooning syndrome is often misdiagnosed. Despite the frequently dramatic clinical presentation, almost all patients recover fully, and the left ventricular function heavily depressed at presentation, improves rapidly in a period of some days to weeks. The purpose of this paper is to present our experience and to review some published reports about this syndrome [2–4]. 2. Documents and Methodology Ten previously healthy patients were admitted to the Coronary Care Unit of the Academic Hospital Center of Rangueil in Toulouse or in the General Hospitals of Midi Pyrénées Area. Their median age was 52 years (range 48–65 years). Those patients, ten postmenopausal women, were hospitalized for a severe chest pain