History
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.
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Electrocardiogram of a patient with takotsubo cardiomyopathy demonstrating ST-segment elevation in anterior and inferior leads.
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Electrocardiogram from the same patient examined in the previous ECG, obtained several days after initial presentation. This demonstrates resolution of ST-segment elevation, and now with diffuse T-wave inversion and poor R-wave progression.
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Coronary angiogram of a patient with takotsubo cardiomyopathy demonstrating normal coronary arteries.
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Coronary angiogram of a patient with takotsubo cardiomyopathy demonstrating normal coronary arteries.
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Ventriculogram during systole in a patient with takotsubo cardiomyopathy demonstrating apical akinesis.
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Ventriculogram during diastole in a patient with takotsubo cardiomyopathy.
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Echocardiogram of a patient with takotsubo cardiomyopathy during diastole several days after presenting to the emergency department.
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Echocardiogram of a patient with takotsubo cardiomyopathy during systole, which demonstrates apical akinesis. Ejection fraction is 40%.
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Echocardiogram of a patient with takotsubo cardiomyopathy during systole, nearly 2 months after presenting to the emergency department. Note the improved contractility of the apex. Ejection fraction increased from 40% to 65%.
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Echocardiogram of a patient with takotsubo cardiomyopathy during diastole, approximately 2 months after presenting to the emergency department.
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Echocardiogram focused on left ventricle of a patient with takotsubo cardiomyopathy during diastole.
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Echocardiogram focusing on left ventricle of a patient with takotsubo cardiomyopathy during systole. Note apical akinesis.
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Echocardiogram focusing on left ventricle of a patient with takotsubo cardiomyopathy during systole, approximately 2 months after presenting to the emergency department. Note improved apical contraction.
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Echocardiogram focusing on left ventricle of a patient with takotsubo cardiomyopathy during diastole, approximately 2 months after presenting to the emergency department.
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- Presentation
- DDx
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- Treatment
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- Medication Summary
- Salicylates
- Antianginal Agents
- Analgesics
- Anticoagulants
- Low Molecular Weight Heparins
- Antiarrhythmic Agents
- Platelet Aggregation Inhibitors
- Loop Diuretics
- Thiazide Diuretics
- Antihypertensive Agents
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- Angiotensin-converting Enzyme (ACE) Inhibitors
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- Calcium Channel Blockers
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