Clinical characteristics of Takotsubo cardiomyopathy in North America

Abstract

Background:Takotsubo cardiomyopathy (TC) or transient left ventricular apical ballooning syndrome is an acute cardiac syndrome characterized by transient wall motion abnormalities extending beyond a single epicardial vessel in the absence of significant obstructive coronary artery disease.Aim:This study was to describe the clinical characteristics of TC in North America.Materials and Methods:We identified 10 patients who met the Mayo Clinic criteria for TC using our Electronic Medical Records. We also conducted a systematic review of case series of TC that were done in North America by searching the MEDLINE database. We identified 11 case series that met our eligibility criteria.Results:Our systematic review included 620 patients. Chest pain and ST segment elevation were the cardinal features of this syndrome, but the prevalence was lower than in the European and Asian cohort (50% and 39% as compared with 80% and 70%, respectively). Classic precipitating emotional or physical stress was described in > 80% of patients. Cardiac biomarkers were found to be elevated in >90% of our patients.Conclusions:TC is a worldwide problem and clinical presentation appears to be similar in North American, European, and Asian countries. However, fewer patients in our cohort presented with typical chest pain and electrocardiography (ECG) changes, which might suggest ethnic variations in the syndrome or perhaps a more aggressive diagnostic approach in North American countries.

Impact of transpulmonary thermodilution-based cardiac contractility and extravascular lung water measurements on clinical outcome of patients with Takotsubo cardiomyopathy after subarachnoid hemorrhage: a retrospective observational study

“…One distinct morphological variant of this phenomenon is apical ballooning syndrome, known as Takotsubo cardiomyopathy (TCM), which is characterized by hypokinesis of the basal and middle portions of the left ventricle [ 2 ]. Although TCM may be reversible or self-limiting, it contributes significantly to morbidity and mortality after SAH, especially when it is combined with other neurogenic injuries, such as flash pulmonary edema and cardiogenic shock [ 3 ]. Furthermore, left ventricular (LV) dysfunction associated with TCM combined with cerebral vasospasm may increase the risk of delayed cerebral ischemia (DCI) [ 4 , 5 ], and thus it may impact clinical outcome [ 6 ].…”

Left ventricular mass formulae and prevalence rates of echocardiographic left ventricular hypertrophy in Nigerians with essential hypertension

“…[4] In view of the low sensitivity of ECG in detecting LVH, echocardiography has become the preferred mode of investigation in patients with hypertension. In addition to the detection of LVH, echocardiographic examination of hypertensive patients or other individuals with cardiac complaints[56] also provide additional information on cardiac structure and functions, such as the degree of atrial enlargement, ventricular geometric pattern and diastolic dysfunction. In terms of prognostic value, it is established that echocardiographically determined LVH is one of the powerful independent risk factors for cardiovascular morbidity, cardiovascular complications, and mortality.…”

Case report of Tako-Tsubo cardiomyopathy associated with repetitive anaesthesia in a female patient with Tako-Tsubo cardiomyopathy

“…It is also known as “takotsubo syndrome” [ 3 , 4 ], “broken heart syndrome” [ 4 , 5 ], “transient left-ventricular apical ballooning syndrome” [ 5 - 7 ], “stress-induced cardiomyopathy” [ 5 , 8 ], “ampulla cardiomyopathy” [ 4 , 8 ], or “stress-induced myocardial stunning” [ 9 , 10 ]. Although the syndrome is usually induced by a sudden stress reaction, symptoms may also occur without any detectable cause.…”

“…The syndrome usually manifests like acute myocardial infarction but is characterized by generally reversible left ventricular dysfunction with typical akinesia of the apical segments and hypercontractility of the basal segments and is associated with emotional or physical stress (Figure 1 ) [ 5 , 7 , 10 ].

Figure 1 Normal heart (A) and Tako-Tsubo sign (B) with apical ballooning (end-systolic view).

…”

“…It occurs most often in post-menopausal women and it is usually triggered by emotional or physical stress, with complete recovery of left ventricular systolic function within a few days or weeks. For diagnosis, significant coronary artery disease has to be absent [ 5 ]. The diagnosis of TTC should be based on the following Mayo Clinic criteria [ 11 ]: (a) transient akinesia or dyskinesia of left ventricular apical and/or midventricular segments; (b) no angiographic evidence > 50% coronary artery stenosis, or plaque rupture, or intracoronary thrombus formation; (c) new electrocardiographic (ECG) abnormalities (dynamic ST-T changes or T-wave inversion); (d) absence of intracranial bleeding, phaeochromocytoma, and myocarditis.…”