Takotsubo Cardiomyopathy

Several relatively recent case reports and series have described a condition featuring symptoms and signs of acute myocardial infarction without demonstrable coronary artery stenosis or spasm in which the heart takes on the appearance of a Japanese octopus fishing pot called a takotsubo (Figure 1). In takotsubo cardiomyopathy (also called transient apical ballooning and stress cardiomyopathy), left ventricular dysfunction, which can be remarkably depressed, recovers within a few weeks.1–4 Figure 1 Left ventriculogram (A, end-diastolic phase; B, end-systolic phase) in the right anterior oblique projection. The extensive area around the apex shows akinesis, and the basal segments display hypercontraction, especially in the end-diastolic phase. C, ... Takotsubo cardiomyopathy occurs predominantly in post-menopausal women soon after exposure to sudden, unexpected emotional or physical stress. For instance, the incidence of takotsubo cardiomyopathy increased substantially in elderly women living near the epicenter of the Niigata earthquake.4 Although the left ventricular dysfunction is transient and there is no evidence of obstructive epicardial coronary disease, an increasing number of angioplasty procedures have been performed for presumed acute coronary syndromes. Concepts about the demographics, clinical features, prognosis, and management of this reversible form of left ventricular failure are still evolving. In this brief review, we summarize recent clinical reports and discuss an animal model that may clarify the pathogenesis of this condition.