Takotsubo Cardiomyopathy Clinical Presentation

Updated: Jan 17, 2017
  • Author: Eric B Tomich, DO; Chief Editor: Erik D Schraga, MD  more...
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The clinical presentation of patients ultimately diagnosed with takotsubo cardiomyopathy (TCM) is usually indistinguishable from that of patients with acute coronary syndrome (ACS). The most common presenting symptoms are chest pain and dyspnea, though palpitations, nausea, vomiting, syncope, and, rarely, cardiogenic shock have been reported.

One of the more unique features of TCM is its association with a preceding emotionally or physically stressful trigger event, occurring in approximately two thirds of patients. Unlike ACS, for which the peak occurrence is during the morning hours, TCM events are most prevalent in the afternoon, when stressful triggers are more likely to take place. [27]

A large systematic review found that patients with TCM tend to have a lower incidence of traditional cardiac risk factors, such as hypertension, hyperlipidemia, diabetes, smoking, or positive family history for cardiovascular disease. [22]


Physical Examination

Physical examination findings are nonspecific and often normal, but the patient may exhibit the clinical appearance of ACS or acute congestive heart failure (CHF). Patients may appear anxious and diaphoretic. Tachydysrhythmias and bradydysrhythmias have been reported, but the average heart rate in one review was 102 bpm. [6]

Hypotension can occur from a reduction in stroke volume because of acute left ventricular (LV) systolic dysfunction or outflow tract obstruction. Murmurs and rales may be present on auscultation in the setting of acute pulmonary edema.