TakoTsubo cardiomyopathy: unravelling the malignant consequences of a benign disease with cardiac magnetic resonance

Abstract

TakoTsubo cardiomyopathy (TCM) is a unique type of reversible cardiomyopathy that is precipitated by a stressful emotional or physical event. The increasing incidence is due to the greater use of emergency coronary angiography, newer cardiac biomarkers together with more sensitive cardiac imaging techniques. Few case reports have documented how TCM can present with malignant arrhythmias such as torsades de pointes caused by the repolarisation abnormalities or QTc prolongation. Although TCM is usually considered a benign reversible condition, its associated arrhythmic risk is increasingly recognised. TCM often presents as an acute coronary syndrome with unobstructed coronary arteries at angiography. In this patient population, cardiac magnetic resonance (CMR) is a useful tool to establish a differential diagnosis, discriminating TCM from acute myocarditis and myocardial infarction with spontaneous recanalisation. CMR is becoming a promising new diagnostic modality in risk stratifying patients with potential higher arrhythmic risk.

A Case of Recurrent Takotsubo Cardiomyopathy: Not a Benign Entity

“…Takotsubo cardiomyopathy has been found to be associated with physical and emotional triggers. Some of these stressors include pheochromocytoma, myocarditis, psychiatric illnesses, prolonged QT syndromes, COPD exacerbations, albuterol, hyperthyroidism, seizure disorders, electroconvulsive therapy, acute brain injury, and sepsis [6][7][8][9][10][11][12][13][14][15]. For this reason, the syndrome has also been referred to as "stress-induced" cardiomyopathy.…”

Takotsubo cardiomyopathy with severe bradyarrhythmia following epidural insertion

“…Cardiac MRI (CMR) would also be very important where clinical uncertainty or poor echo images resulting in diagnostic doubt. 12 CMR is a useful imaging modality in suspected TTC, as the absence of late gadolinium enhancement rules out a myocardial infarction and the presence of myocardial oedema can point to the diagnosis. If performed in the acute phase, CMR can also help differentiate between myocarditis and TTC.…”

“…This case illustrates that anaesthetist should be vigilant for this increasing recognised cause of cardiovascular compromise and request an early echocardiogram in suspected cases. 12 Learning points ▸ Takotsubo cardiomyopathy (TTC) is an increasingly recognised clinical condition. ▸ TTC can mimic other cardiac conditions and early investigation with echo and coronary imaging is important to avoid unnecessary therapy, for example, thrombolysis.…”

Role of cardiovascular magnetic resonance in acute and chronic ischemic heart disease

“…3 e). Though it was once believed that in TTC LGE is absent, LGE has been found in a non-negligible proportion of cases, probably as a reflection of an underlying inflammatory response and transitory increase of extracellular space due to the myocardial oedema [ 44 ]. This is however reversible and no longer observed at follow-up in conjunction with the resolution of myocardial oedema/inflammation.…”