A new variant of Tako-tsubo cardiomyopathy: transient mid-ventricular ballooning

Abstract

Stress cardiomyopathy is a reversible left ventricular dysfunction precipitated by emotional stress. Affected patients are generally women, whose symptoms are similar to myocardial infarction with reversible apical dyskinesis associated with hypercontractile basal segments and no evidence for hemodynamically significant coronary arterial stenoses by angiography. We report the case of an 82-year-old woman who presented with acute onset of chest pain after emotional stress and with reversible left ventricular dysfunction consisting of akinesis of the midventricular segments and hyperkinesis of the basal and apical segments.

Current state of knowledge on Takotsubo syndrome: a Position Statement from the Taskforce on Takotsubo Syndrome of the Heart Failure Association of the European Society of Cardiology

“…Two other variants are common: the inverted Takotsubo or basal variant, with circumferential basal hypokinesia and apical hypercontractility, also referred to as the ‘nutmeg’ or ‘artichoke’ heart; and the mid left ventricular (MLV) variant, with circumferential mid‐ventricular hypokinesia and both basal and apical hypercontractility . The end‐systolic appearance of the MLV variant has been likened to a Greek vase or the ace of spades; however, the basal variant can also resemble the ace of spades ( Figure ).…”

Occurrence of Tako-Tsubo Cardiomyopathy in Association with Ingestion of Serotonin/Noradrenaline Reuptake Inhibitors

“…All subsequent series of TTC have noted its predominant occurrence in post-menopausal females, who account for approximately 90% of cases [4][5][6][7][8]. The site of predominant left ventricular dysfunction also varies from the classical apical pattern, such that both a predominantly mid-ventricular [9] and a purely basal [10] pattern are now well described. TTC has been associated with an early risk of torsade de pointes [11], of a shock-like state [8], and a substantial risk of late recurrence [12] despite rapid recovery of left ventricular systolic function in most cases.…”

Mechanisms of stress (Takotsubo) cardiomyopathy

“…variant forms of left ventricular dysfunction have been reported, including wall-motion abnormalities, such as midventricular ballooning with sparing of the basal and apical segments, or inverted takotsubo ( Figure 1). [6][7][8][9] involvement of the right ventricle is common in stress cardiomyopathy and associated with more severe left ventricular dysfunction. [10][11][12] any form of contractile dysfunction is transient and reversible, however, with resolution generally achieved within days or weeks.…”