‘Tako-Tsubo’ Transient Ventricular Dysfunction

Abstract

During admission for investigation of dysphagia, an 82-year-old woman suddenly complained of dyspnea, which was followed by cardiogenic shock. Her symptoms, electrocardiogram, echocardiogram and laboratory data were compatible with an extensive acute anterior myocardial infarction. Emergency cardiac catheterization showed no atheromatous narrowing in any coronary artery. However, the contractions of the left and right ventricles were diffusely and severely impaired, except for some hyperkinesis of the basal area. The asynergy, as well as the abnormalities on the ECG, improved almost to normal by the 35th hospital day. An endomyocardial biopsy from the right ventricle during the acute phase showed atypical myocardial damage with proliferation of fine collagen fibers and small round-cell infiltration including polymorphologic leukocytes. This type of transient cardiac disorder has recently been described in Japan, and is called 'Tako-tsubo cardiomyopathy' because of the characteristic appearance of the left ventricular asynergy. In the present case, ventricular asynergy was not limited to the left ventricle, but was also present in the right ventricle.

Tako-tsubo cardiomyopathy as a recurrent disease with doubtful prognosis of recovery and heterogenic symptoms

“…Even though tako-tsubo was first described in the 1990s, no English language studies appeared before 2000 [4]. The two cases we present suggest that recurrence of tako-tsubo is more frequent than previously thought [2,3,[5][6][7][8][9][10][11][12]. Acute manifestation imitating acute myocardial infarction may be a part of the clinical course of the disease, which is characterized by long periods of remission and sudden onsets with doubtful prognosis of recovery [14].…”

“…Both are characterized by similar clinical symptoms; however their origin is totally different. In variant angina, myocardial stunning is caused by vasospasm with subsequent loss of coronary flow reserve, which may be sometimes difficult to prove in coronary angiography [10,12]. An increase of sympathomimetic activity, a deficit of estrogen hormones and retention of potassium ions in extracellular spaces result in a microvascular flow deficit which plays a great role in the etiology of ABS [10].…”

“…In a typical case of tako-tsubo cardiomyopathy, elevation of ST segment in the ECG lasts usually three days from the sudden onset of angina, then T waves inversion and QT extension can be observed. Contractility dysfunction regresses after up to 30 days [2,3,10]. We present two case reports of recurrent tako-tsubo cardiomyopathy without elevation of ST segments in the ECG.…”

Transient left ventricular dysfunction (tako-tsubo phenomenon): Findings and potential pathophysiological mechanisms

“…Other underlying disorders reported in patients with TTP include depression (23,43,44), dementia (23), chronic emphysema (23), chronic obstructive pulmonary disease (20,43), hyperthyroidism (20,42), retroperitoneal fibrosis (45), ShyDrager syndrome (40), hypokalemia-related myopathy (46), Guillain-Barré syndrome (47,48), myasthenia gravis (49), syndrome malin (44), amyotrophic lateral sclerosis (50), metabolic myopathy (51), Parkinson's disease (44), neurosis (22), pulmonary fibrosis (22), alcoholism (22,46), acute renal failure (22), hepatic cirrhosis (52), chronic pancreatitis (52), rheumatoid arthritis (20) and dysphagia (53).…”

“…Intravascular ultrasound (IVUS), performed on five consecutive TTP patients, showed a single, ruptured, atherosclerotic plaque in each patient in the middle portion of the left anterior descending coronary artery (57). Myocardial biopsy has been performed in several cases with TTP and revealed unspecific findings such as adipose tissue, mild interstitial lymphoid infiltration, slight interstitial fibrosis, mildly atrophic myocardial fibres and small numbers of mononuclear cells (4,16,(20)(21)(22)(23)53).…”