Takotsubo Cardiomyopathy: A Review

Takotsubo cardiomyopathy (TTC) is characterized by transient regional systolic dysfunction of the left ventricle in the absence of angiographic evidence of obstructive coronary artery disease or acute plaque rupture. In most cases of takotsubo cardiomyopathy, the regional wall motion abnormality extends beyond the area perfused by a single epicardial coronary artery. It mimics acute coronary syndrome and shows female preponderance. Since the original description of Takotsubo cardiomyopathy showing apical ballooning due to apical akinesis or hypo kinesis with preserved or hyper contractile basal segments (the classic or apical type), three other patterns of left ventricular involvement have been described. These are the inverted (reverse) type, the mid ventricular type and the localized type. Although the clinical presentation, outcome and management are mostly similar between the groups, patients with inverted TTC tend to be younger than those with other types of TTC. A triggering stress is usually present in patients with classic TTC, but almost always present in patients with the inverted type of TTC. Patients with the inverted TTC tend to have lower prevalence of dyspnea, pulmonary edema, cardiogenic shock, T -wave inversion and acute reversible mitral regurgitation but significantly higher levels of creatine kinase MB fraction (CK-MB) and troponins compared to classic TCC. TTC may develop in various stressful situations. Awareness of the condition is important for its early detection and treatment and also for differentiating it from acute myocardial infarction.