Takotsubo Cardiomyopathy
  • Also known as stress induced cardiomyopathy.
  • Results in usually transient left ventricle dysfunction. Often patients have good prognosis as there ventricular function will usually recover within a few months.
  • Need to rule out significant coronary disease to make diagnosis.
  • Thought to be related to catecholamine surge.
  • Most commonly seen in postmenopausal women.
  • Need to consider a pheochromocytoma especially is recurrent.

Clinical Presentation

  • Typically presents like an ACS presentation with chest pain, ekg changes, and troponin elevation.
  • EKG features can include diffuse T-wave inversions, ST elevation, also typically get QT prolongation with ST/T waves changes.
  • ¬†Complications from Takotsubo can range from life threatening arrhythmias such as VT, LVOT obstruction from basal segment hyperdynamism, heart failure, LV thrombus, significant MR from SAM.

Example 1 Apical Akinesis

  • Note the parasternal long axis, apical two and four chamber views demonstrating the basal segment contracting well with clear evidence of apical akinesis.
  • Just one month later the patient has had complete recovery of left ventricular function.

Variants of Takotsubo

  1. Apical akinesis the most common variant. Usually has some degree of midventricular involvement.
  2. Isolated midventricular.
  3. Reverse Takotsubo or basal akinesia.

Treatment

  1. Beta-Blocker
  2. ACE-Inhibitor
  3. Anticoagulation: Treat is known LV thrombus. Consider prophylactic anticoagualtion especially in high risk.
  4. Repeat TTE in 1-3 months, usually see  recovery of LV function.
  5. If shock and LVOT obstruction, consider heart rate control, and phenylephrine.
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