Takotsubo (Stress-Induced) Cardiomyopathy in Two Women with Suspected Myocardial Infarction

www.turner-white.com T akotsubo cardiomyopathy is a nonischemic cardiomyopathy characterized by reversible left ventricular dysfunction that is seen predominantly in postmenopausal women. Also known as stress-induced cardiomyopathy, broken heart syndrome, and transient left ventricular apical ballooning syndrome, it classically presents with signs and symptoms similar to those of an acute coronary syndrome (ACS), with the onset of symptoms typically provoked by an intense emotional or physical event. Coronary angiography in patients with takotsubo cardiomyopathy usually reveals normal arteries and a characteristic wall motion abnormality: the apical portion of the left ventricle is transiently hypokinetic or akinetic, and there is compensatory hyperkinesis of the basal walls, causing the apex to have a ballooned out appearance during systole. The syndrome was named “takotsubo cardiomyopathy” by clinicians in Japan because the shape of the left ventricular apical ballooning resembles a traditional Japanese octopus trap, or tako-tsubo (Figure 1). Takotsubo cardiomyopathy increasingly is being recognized as a cause of reversible left ventricular dysfunction, especially in postmenopausal women. Because its initial presentation is similar to that of ACS, physicians should be aware of its distinguishing features. This article reports 2 cases of takotsubo cardiomyopathy and discusses the pathophysiology, clinical features, and management of the syndrome.