A Syndrome of Transient Left Ventricular Apical Wall Motion Abnormality in the Absence of Coronary Disease: A Perspective from the United States

Abstract

Background: The syndrome of chest pain associated with characteristic anterior electrocardiographic changes, moderate increases in cardiac enzymes, and a reversible apical wall motion abnormality in the absence of coronary artery disease has been documented in Japan, but has received relatively little attention in other countries. Methods: The clinical and echocardiographic data of 12 patients (11 women, mean age 64 ±14 years) who presented with chest symptoms, electrocardiographic (ECG) changes indicative of an acute anteroapical myocardial infarction, abnormal cardiac enzyme levels and echocardiography showing an apical wall motion abnormality were collected. Coronary angiography was performed in 10 patients. A follow-up echocardiogram was obtained within 2 weeks of the initial diagnosis in most cases. Results: An identifiable, precipitating (‘trigger’) event could be identified in all 12 individuals. Respiratory distress was present in 7, the death of a relative in 3, in 4 a surgical or medical procedure had been performed, and in 1 a panic disorder was diagnosed. The echocardiograms showed a characteristic wall motion pattern of significant apical dysfunction. All of the patients who underwent coronary arteriography had noncritical coronary artery disease. Follow-up echocardiography showed normalization of the LV dysfunction in all instances. Conclusion: We identified a syndrome of chest pain, dyspnea, ECG and enzyme changes mimicking acute myocardial infarction, similar to the ‘Takotsubo’ syndrome described in Japan. It is likely that the widespread use of echocardiography, coupled with increased recognition of this syndrome, will result in this diagnosis being made more commonly.

Síndrome de Tako-Tsubo: caso clínico

“…Los resultados a corto plazo del STT son excelentes, con resolución completa 18 ; sin embargo, no hay datos claros del pronóstico a largo plazo. Respecto a una eventual persistencia de las alteraciones segmentarias, en relación a disturbios de catecolaminas, existe evidencia de alteración apical precoz y hasta 6 meses mediante imágenes con metayodobenzilguanidina marcada 19 .…”

Cardiomiopatia de Takotsubo: uma causa rara de choque cardiogênico simulando infarto agudo do miocárdio

“…The reversibility of contractile change of LV and the absence of significant obstructive coronariopathy are the important aspects for the diagnosis, and, on average, up to the 18 th day from the beginning of the symptoms the total reestablishing of the ventricular function is observed, with a variation from 3 to 50 days 6,7 . It is more usual in women after the 5 th decade of age, usually unleashed by emotional factors, surgery or acute disease 8 . Many cases have been described in Japan, United States and Europe 8 .…”

“…In Brazil, there are few reports 9 . The submission with cardiogenic shock is particularly less frequent, which only occurs in 4% of the cases 6,8 .…”

“…The differential diagnosis must be done with pheochromocytoma, changes in segmental contraction secondary to encephalic vascular accident and subarachnoidal hemorrhage, besides acute coronary syndromes 6,7,8 . Upon the submission with supraunlevelling of segment ST, differentiating such situation from acute myocardial infarction is practically impossible without the findings of coronary angiography and many of those patients have thrombolytic inadvertently 9 .…”

Dressler’s syndrome as a complication of apical ballooning cardiomyopathy

“…[1,2] For proper diagnosis, other causes of wall motion abnormalities such as coronary heart disease, myocarditis and other types of cardiomyopathies have to be excluded. [3][4][5] Takotsubo syndrome affects primarily post-menopausal women, but can also affect younger women and men.…”