Takotsubo cardiomyopathy associated with rupture of the left ventricular apex: assessment of histopathological features of a fatal case and literature review

Abstract

Takotsubo cardiomyopathy, also known as "broken heart syndrome," is a cardiac entity characterized by transient left ventricular dysfunction without obstructive atherosclerotic coronary artery disease. An episode of emotional stress is believed to act as a trigger in the development of this syndrome, which typically occurs in female patients. We report a fatal case of a previously healthy 70-year-old woman who suffered an out-of-hospital cardiac arrest and cardiac rupture during emotional distress, due to Takotsubo cardiomyopathy. Ventricular rupture with Takotsubo cardiomyopathy is rare, but our case emphasizes the importance of dealing with this serious and potentially life-threatening disease. Takotsubo cardiomyopathy should be considered as a differential diagnosis in cases of early-developing heart failure, and clinicians should subsequently use adequate diagnostic and therapeutic options.

Reversible Dilated Cardiomyopathy: Into the Thaumaturgy of the Heart—Part 1

“…15 Sporadic left ventricular rupture has been described. 16 Emotional and physical stressful events are typical triggers of TTC, although in one third of patients no trigger is found. In this situation diagnosis may be more difficult.…”

Left ventricular apical thinning

“…Researchers have also reported on Takotsubo and transient LV apical ballooning, which are associated with hyperkinetic basal segments and apical dyskinesia or akinesia due to increased emotional stress without coronary artery disease. The course of the disease is usually benign and reversible; however, documents describing the rupture of the apex are present 19–22 . Apical ballooning due to ischemia‐induced apical dyskinesis may also occur 23 .…”

“…The course of the disease is usually benign and reversible; however, documents describing the rupture of the apex are present. [19][20][21][22] Apical ballooning due to ischemia-induced apical dyskinesis may also occur. 23 Iatrogenic pathologies are also possible, as reports of left ventricular free wall perforation during transcatheter aortic valve replacement (TAVR).…”

Do pathologists agree on how to diagnose takotsubo cardiomyopathy?

“…Whenever a patient dies within 24 h after the onset of TTC-like symptoms, it is clinically important to study the case in detail, as the authors diligently tried to do [1]. Indeed, TTC is a possible explanation for broken-heart syndrome; however, in this case, the following points merit further consideration:…”

“…I read with great interest the report by Indorato et al [1] regarding takotsubo transient cardiomyopathy (TTC). The authors described a case of sudden death in which the autopsy findings featured apical rupture of the myocardium.…”