Stress Induced Takotsubo CM

What are the other names for stress-induced cardiomyopathy?

Stress-induced cardiomyopathy is also called Takotsubo cardiomyopathy and broken heart syndrome.

Where does “Takotsubo” come from?

“Takotsubo” comes from a Japanese word for an octopus fishing pot.

What is Takotsubo cardiomyopathy?

Takotsubo is transient systolic dysfunction and heart failure that mimics an MI, but occurs in the absence of obstructive CAD.

How is Takotsubo cardiomyopathy finally diagnosed?

The final diagnosis is made with LHC.

What is the etiology of stress-induced cardiomyopathy?

It is idiopathic. There may be a higher prevalence of chronic anxiety disorders before the illness.

What can trigger Takotsubo cardiomyopathy?

It can be triggered by acute medical illness or emotional distress, such as death of a family member, surgery, severe pain, catastrophic medical diagnosis, emotional stressor, etc.

Explain the pathophysiology of stress-induced cardiomyopathy.

The precipitating mechanisms are complex and poorly understood.
Abnormal catecholamine dynamics play a role and can cause:

1. Increased intracellular calcium concentration

2. Contraction band necrosis

3. More apical involvement because there is more adrenoceptor concentration in the apex compared to the mid or basal regions

Who is Takotsubo more common in?

Takotsubo more common in post-menopausal women

Over 90% of cases are in post-menopausal women.

Why is Takotsubo more common in post-menopausal women?

Estrogen may play a role because the incidence is predominantly in post-menopausal women.

What type of heart failure is Takotsubo?

It is an acute yet reversible heart failure.

How does Takotsubo usually present clinically? List 4

It presents the same as a patient with an MI would, including:

1. Chest pain

2. SOB

3. Elevated troponin

4. ST elevation on EKG

What are the main echo findings of Takotsubo cardiomyopathy? List 5

The most common finding is apical ballooning, akinesis, or dyskinesis with preserved basilar function.
Wall motion abnormalities may also include the mid or base region.

What systolic function and RV findings can be seen?

Reduced systolic dysfunction is typically 20–49%.
RV involvement is rare.

What complications or extra findings should be assessed on echo? List 3

Echo should assess for:

1. Possible LVOTO from basal hyperkinesis/overcompensation

2. Apical thrombus

3. MR

What is the treatment for stress-induced cardiomyopathy? List 4

Treatment includes:

1. Treat systolic dysfunction

2. IABP/MCS in severe cases

3. ACE inhibitors, beta blockers, anticoagulants

4. Usually resolves on its own within 1–4 weeks