Takotsubo Cardiomyopathy

Since the first report in 1990, takotsubo cardiomyopathy (TTC) has been increasingly recognized as a novel form of nonischemic acute cardiomyopathy. It is an important differential in diagnosis of acute coronary syndrome (ACS) due to its similar presentation. However, it distinguishes itself from an ACS in the fact that regional wall motion abnormalities extend beyond a single coronary vascular bed and are reversible, and epicardial coronary occlusion is absent (1). In TTC, left ventricular (LV) dysfunction can be remarkably depressed but recovers within a few weeks (2) in the vast majority of patients. This syndrome has been described by more than 75 individual descriptive names in the literature, emphasizing those disease features that were most impressive to individual investigators (3) (Table 1). Increased awareness about this syndrome has led to its incorporation into the American Heart Association classification of reversible cardiomyopathies (4,5). Pathogenesis of this syndrome is still not well understood, although physical and emotional stressors and mediation by pathologic sympathetic myocardial stunning are believed to play key roles. However, in an important minority of patients, a detailed personal history does not elicit an antecedent event (3).