Takotsubo cardiomyopathy (TC) is a condition which has been described predominantly in postmenopausal women following exposure to sudden, unexpected emotional or physical stress.
There is a transient left ventricular dysfunction and there is no evidence of obstructive epicardial coronary disease.
While there is no definite consensus on the diagnostic criteria for Takotsubo cardiomyopathy.
A set of diagnostic criteria were proposed in 2004 by researchers at the Mayo Clinic, which have been modified recently 1:
- transient hypokinesis, akinesis, or dyskinesis in the left ventricular mid segments with or without apical involvement; regional wall motion abnormalities that extend beyond a single epicardial vascular distribution; and frequently, but not always, a stressful trigger
- absence of obstructive coronary disease or angiographic evidence of acute plaque rupture
- new ECG abnormalities (ST-segment elevation and/or T-wave inversion) or modest elevation in cardiac troponin
- absence of pheochromocytoma and/or myocarditis
Patients with Takotsubo cardiomyopathy can have high levels of serum catecholamines and plasma brain natriuretic peptide (BNP). The secretion pattern of BNP in takotsubo patients can be quite similar to those with a myocardial infarction.
Four distinct patterns of dyskinesia and ballooning are recognised: apical (most common), biventricular, mid-ventricular and basal.
There is typically an absence of late enhancement on delayed contrast sequences, which differentiates Takotsubo cardiomyopathy from anterior STEMI
There can high T2 intensity signal (directly relating to water content in the myocardial wall), the oedema is typically located in the apical mid ventricular planes and spares the basal plane, and matches the wall-motion abnormalities seen on cine MRI.
- MR perfusion: usually normal
History and etymology
The word tako-tsubo in Japanese refers to a pot used to catch octopi (see Figure 1) 2. It is thought to have been first described by Keigo Dote et al in 1991 5.
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