Takotsubo cardiomyopathy: Difference between revisions
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==Background== | ==Background== | ||
[[File:Takotsubo.png|thumbnail|A depicts the left ventricular dilation that occurs in Takotsubo cardiomyopathy compared to a normal heart in B.]] | |||
*AKA transient apical ballooning syndrome or stress-induced cardiomyopathy | *AKA transient apical ballooning syndrome or stress-induced cardiomyopathy | ||
*Bulging out of LV apex with preserved function of the base looks like an octopus pot or "tako tsubo" in Japanese | |||
*85% of cases caused by stressful event before symptoms (death of loved one, fear, argument, asthma, surgery, stroke, etc.)<ref> Sharkey, S., Lesser, J., & Maron, B. (2011). Takotsubo (stress) cardiomyopathy. American Heart Association.</ref> | |||
**Proposed mechanisms include vasospasm and abnormal response to catecholamine surge | |||
==Clinical Features== | ==Clinical Features== | ||
*Mimics [[Acute Coronary Syndrome]] | *Mimics [[Acute Coronary Syndrome]] | ||
*Chest Pain | *Chest Pain | ||
*Dyspnea | *Dyspnea | ||
*[[Cardiogenic Shock]] | *[[Cardiogenic Shock]] and sudden [[CHF]] | ||
*Lethal arrhythmia (e.g. VT/VF, PEA) | *Lethal arrhythmia (e.g. VT/VF, PEA) | ||
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**Systolic Dysfunction (with ejection fraction dropping from normal to <25-35%) | **Systolic Dysfunction (with ejection fraction dropping from normal to <25-35%) | ||
**Reduced contractility not explained by single vessel disease | **Reduced contractility not explained by single vessel disease | ||
*Ventriculography | |||
**Shows LV ballooning | |||
[[File:Takotsubo ventriculography.gif|thumbnail|LV apical ballooning during systole]] | |||
*Angiogram or L Heart Cath | *Angiogram or L Heart Cath | ||
**No | **No significant coronary blockage to explain LV dysfunction | ||
==Management== | ==Management== | ||
*Mainly supportive as no true lesion | |||
*Treat as STEMI initially | |||
*Manage Cardiogenic Shock and acute pulmonary edema | |||
Manage Cardiogenic Shock and acute pulmonary edema | **IVF | ||
**Beta Blockers and ACE Inhibitors are commonly used for Takotsuba | |||
Beta Blockers and ACE Inhibitors are commonly used for Takotsuba | ***Disease believed to be caused by catecholamines, do not want to give inotropes | ||
Anticoagulation may be considered | **Anticoagulation may be considered | ||
**Consider Intra-aortic balloon pump | |||
Consider Intra-aortic balloon pump | |||
==Prognosis== | ==Prognosis== | ||
Ejection Fraction returns to normal (at least >50%) in nearly all cases | Ejection Fraction returns to normal (at least >50%) in nearly all cases | ||
Mortality 2% during hospitalization | Mortality 2% during hospitalization | ||
Recurrence in 5-6% | Recurrence in 5-6% | ||
==Disposition== | ==Disposition== | ||
*Admit for post catheterization care | |||
==See Also== | ==See Also== | ||
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==External Links== | ==External Links== | ||
[[Cardiomyopathy (Main)]] | |||
==References== | ==References== | ||
Revision as of 02:35, 2 December 2015
Background
- AKA transient apical ballooning syndrome or stress-induced cardiomyopathy
- Bulging out of LV apex with preserved function of the base looks like an octopus pot or "tako tsubo" in Japanese
- 85% of cases caused by stressful event before symptoms (death of loved one, fear, argument, asthma, surgery, stroke, etc.)[1]
- Proposed mechanisms include vasospasm and abnormal response to catecholamine surge
Clinical Features
- Mimics Acute Coronary Syndrome
- Chest Pain
- Dyspnea
- Cardiogenic Shock and sudden CHF
- Lethal arrhythmia (e.g. VT/VF, PEA)
Differential Diagnosis
ST Elevation
- Cardiac
- ST-segment elevation myocardial infarction (STEMI)
- Post-MI (ventricular aneurysm pattern)
- Previous MI with recurrent ischemia in same area
- Wellens' syndrome
- Coronary artery vasospasm (eg, Prinzmetal's angina)
- Coronary artery dissection
- Pericarditis
- Myocarditis
- Aortic dissection in to coronary
- Left ventricular aneurysm
- Left ventricular pseudoaneurysm
- Early repolarization
- Left bundle branch block
- Left ventricular hypertrophy (LVH)
- Myocardial tumor
- Myocardial trauma
- RV pacing (appears as Left bundle branch block)
- Brugada syndrome
- Takotsubo cardiomyopathy
- AVR ST elevation
- Other thoracic
- Metabolic
- Drugs of abuse (eg, cocaine, crack, meth)
- Hyperkalemia (only leads V1 and V2)
- Hypothermia ("Osborn J waves")
- Medications
Cardiomyopathy
- Dilated cardiomyopathy
- Hypertrophic cardiomyopathy
- Restrictive cardiomyopathy
- Peripartum cardiomyopathy
- Takotsubo cardiomyopathy
- Arrhythmogenic right ventricular dysplasia
Diagnosis
- Troponin frequently elevated
- ECG
- May mimic STEMI
- Frequently affects the anterior distribution and to a lesser extent inferior distribution
- Echocardiogram
- Systolic Dysfunction (with ejection fraction dropping from normal to <25-35%)
- Reduced contractility not explained by single vessel disease
- Ventriculography
- Shows LV ballooning
- Angiogram or L Heart Cath
- No significant coronary blockage to explain LV dysfunction
Management
- Mainly supportive as no true lesion
- Treat as STEMI initially
- Manage Cardiogenic Shock and acute pulmonary edema
- IVF
- Beta Blockers and ACE Inhibitors are commonly used for Takotsuba
- Disease believed to be caused by catecholamines, do not want to give inotropes
- Anticoagulation may be considered
- Consider Intra-aortic balloon pump
Prognosis
Ejection Fraction returns to normal (at least >50%) in nearly all cases Mortality 2% during hospitalization Recurrence in 5-6%
Disposition
- Admit for post catheterization care
See Also
External Links
References
- ↑ Sharkey, S., Lesser, J., & Maron, B. (2011). Takotsubo (stress) cardiomyopathy. American Heart Association.