Takotsubo Cardiomyopathy: A Review - Abstract
Takotsubo cardiomyopathy (TTC) is characterized by transient regional systolic
dysfunction of the left ventricle in the absence of angiographic evidence of obstructive
coronary artery disease or acute plaque rupture. In most cases of takotsubo
cardiomyopathy, the regional wall motion abnormality extends beyond the area
perfused by a single epicardial coronary artery. It mimics acute coronary syndrome
and shows female preponderance.
Since the original description of Takotsubo cardiomyopathy showing apical
ballooning due to apical akinesis or hypo kinesis with preserved or hyper contractile
basal segments (the classic or apical type), three other patterns of left ventricular
involvement have been described. These are the inverted (reverse) type, the mid -
ventricular type and the localized type. Although the clinical presentation, outcome and
management are mostly similar between the groups, patients with inverted TTC tend
to be younger than those with other types of TTC. A triggering stress is usually present
in patients with classic TTC, but almost always present in patients with the inverted
type of TTC. Patients with the inverted TTC tend to have lower prevalence of dyspnea,
pulmonary edema, cardiogenic shock, T -wave inversion and acute reversible mitral
regurgitation but significantly higher levels of creatine kinase MB fraction (CK-MB) and
troponins compared to classic TCC.
TTC may develop in various stressful situations. Awareness of the condition is
important for its early detection and treatment and also for differentiating it from
acute myocardial infarction.