Takotsubo cardiomyopathy: a possible metabolic disorder

Takotsubo cardiomyopathy is considered a transient nonischemic cardiomyopathy of possible metabolic etiology. Based on the morphology of the left ventricle and presumed etiology, this condition has been described using several different names including transient left ventricular apical ballooning, ampulla cardiomyopathy, stress-induced cardiomyopathy, neurogenic stunned myocardium, broken heart syndrome and acute catecholamine cardiomyopathy. The term “takotsubo” means octopus trap and is derived from the Japanese to describe the characteristic appearance of the left ventricle in this condition. In the typical or classic form of takotsubo cardiomyopathy the apical and mid-segment contractile function of the left ventricle is depressed with compensatory hyperkinesis of the basal part thus acquiring an octopus trap or balloon shape during systole. However, several other forms have also been described. The left ventricular dysfunction is not confined to any single area of the coronary artery and the coronary angiogram typically shows nonobstructive coronary arteries. The exact etiology is not known; however, abnormal catecholamine metabolism and response is believed to be the most likely explanation. Preceding emotional and physical stress is recognized in at least 30% of patients. The clinical presentation is acute and mimics ST-elevation myocardial infarction due to symptoms of chest pain, electrocardiographic changes and raised troponin. The widespread availability of primary percutaneous coronary intervention and awareness of takotsubo cardiomyopathy has led to an increasing number of patients being diagnosed with this condition. The treatment is supportive, the prognosis is excellent, and the left ventricular dysfunction is transient, and most patients make a full recovery without myocardial fibrosis or any long-term sequelae. L Heart Metab; 2014;62:36–40