Takotsubo Cardiomyopathy: A New Form of Acute, Reversible Heart Failure

Abstract

everal relatively recent case reports and series have described a condition featuring symptoms and signs of acute myocardial infarction without demonstrable coronary artery stenosis or spasm in which the heart takes on the appearance of a Japanese octopus fishing pot called a takotsubo (Figure 1).In takotsubo cardiomyopathy (also called transient apical ballooning and stress cardiomyopathy), left ventricular dysfunction, which can be remarkably depressed, recovers within a few weeks.[1][2][3][4] Takotsubo cardiomyopathy occurs predominantly in postmenopausal women soon after exposure to sudden, unexpected emotional or physical stress.For instance, the incidence of takotsubo cardiomyopathy increased substantially in elderly women living near the epicenter of the Niigata earthquake. 4 Although the left ventricular dysfunction is transient and there is no evidence of obstructive epicardial coronary disease, an increasing number of angioplasty procedures have been performed for presumed acute coronary syndromes.Concepts about the demographics, clinical features, prognosis, and management of this reversible form of left ventricular failure are still evolving.In this brief review, we summarize recent clinical reports and discuss an animal model that may clarify the pathogenesis of this condition. History of the ConditionMany case reports and series have demonstrated acute, severe, reversible left ventricular dysfunction that coronary ischemia, aortic valvular lesions, or myocarditis cannot explain.Iga et al 5 reported a case of reversible left ventricular dysfunction associated with pheochromocytoma in which the takotsubo appearance was first described, although they did not use the term takotsubo.The authors also inferred that high circulating concentrations of catecholamines could directly damage the myocardium.5 In 1990, Sato et al 6 first described this reversible cardiomyopathy as tako-tsubo-like left ventricular dysfunction; outside Japan, this phenomenon was called apical ballooning 7 or stress cardiomyopathy.8 After 2000, many case reports cited associations with emotional stress, normal coronary angiography, and minimally increased serum levels of cardiac enzymes.