Takotsubo cardiomyopathy: presentation, diagnosis and outcome
THE CONTEXT
Takotsubo syndrome is acute left ventricular dysfunction with dilatation of the apex and adjacent myocardium. Its mechanism is poorly understood.
Triggers and clinical presentation
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Trigger: Acute environmental or emotional stress, such as bereavement, is often associated with onset.
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Symptoms: Chest pain, breathlessness and sometimes cardiac failure occur.
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Sex distribution: The condition occurs more frequently in women than in men.
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Neurological associations: Neurological disorders are present in 15%–20% of cases, including prior cerebrovascular events, neurodegenerative disorders, migraine and epilepsy.
Diagnostic findings
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Acute coronary syndrome mimic: Symptoms and the electrocardiogram often mimic acute ST elevation acute coronary syndrome.
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Coronary angiography: Diagnosis is usually made when angiography shows absent or minimal coronary artery disease.
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Ventricular imaging: Echocardiography or left ventriculography shows characteristic apical ballooning of the left ventricle.
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Ventricular shape: The dilated apex and narrow outflow resemble a Japanese octopus trap, called a takotsubo.
Recovery, longer-term risk and treatment
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Ventricular recovery: Left ventricular ejection fraction returns to normal within days to weeks.
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Longer-term outcomes: The reported recurrence rate is 10%, and mortality is 20% at 5 years.
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Beta-blockers: These reduce the risk of recurrence and may reduce mortality.