Takotsubo cardiomyopathy: Difference between revisions
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==Management== | ==Management== | ||
*Mainly supportive as no true lesion | *Mainly supportive as no true lesion and transient | ||
*Treat as STEMI initially | *Treat as STEMI initially | ||
*Manage Cardiogenic Shock and acute pulmonary edema | *Manage Cardiogenic Shock and acute pulmonary edema | ||
**IVF | **IVF | ||
**With LVOT obstruction | |||
**Without LVOT obstruction | |||
**Beta Blockers and ACE Inhibitors are commonly used for Takotsuba | **Beta Blockers and ACE Inhibitors are commonly used for Takotsuba | ||
*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 | ||
==Disposition== | ==Disposition== | ||
Revision as of 03:35, 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 and transient
- Treat as STEMI initially
- Manage Cardiogenic Shock and acute pulmonary edema
- IVF
- With LVOT obstruction
- Without LVOT obstruction
- Beta Blockers and ACE Inhibitors are commonly used for Takotsuba
- Anticoagulation may be considered
- Consider Intra-aortic balloon pump
Prognosis
Ejection Fraction returns to normal (at least >50%) in nearly all cases
Disposition
- Admit for post catheterization care
See Also
External Links
References
- ↑ Sharkey, S., Lesser, J., & Maron, B. (2011). Takotsubo (stress) cardiomyopathy. American Heart Association.