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Takotsubo cardiomyopathy--a clinical review.

Castillo Rivera AM, Ruiz-Bailén M, Rucabado Aguilar L - Med. Sci. Monit. (2011)

Bottom Line: The electrocardiographic, echocardiographic, and ventriculographic changes resolve spontaneously over a variable period of time (from days to months).There are a number of pathophysiological theories, none of which has been shown to be definitive, suggesting that all of them may be involved to some extent.The prognosis is generally favourable, and recurrence is very rare.

View Article: PubMed Central - PubMed

Affiliation: Department of Critical Care and Emergency, Intensive Medicine Unit, Jaén Hospital Complex, Jaén, Spain. ana.castillorivera@gmail.com

ABSTRACT
Stress cardiomyopathy is characterised by reversible left ventricular dysfunction. It simulates an acute coronary syndrome (ACS), presenting with precordial pain or dyspnoea, changes of the ST segment, T wave, or QTc interval on electrocardiogram, and raised cardiac enzymes. Typical findings are disturbances of segmental contractility (apical hypokinesia or akinesia), with normal epicardial coronary arteries. The true prevalence is unknown, as the syndrome may be under-diagnosed; it is more common in postmenopausal women. There is usually a trigger in the form of physical or psychological stress. The electrocardiographic, echocardiographic, and ventriculographic changes resolve spontaneously over a variable period of time (from days to months). There are a number of pathophysiological theories, none of which has been shown to be definitive, suggesting that all of them may be involved to some extent. The prognosis is generally favourable, and recurrence is very rare.

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Ventriculography image of apical ballooning which shows apical akinesia and basal hyperkinesis.
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f3-medscimonit-17-6-ra135: Ventriculography image of apical ballooning which shows apical akinesia and basal hyperkinesis.

Mentions: Normality of the epicardial coronary arteries is normally a requirement for the diagnosis of TS [4,7,13,74]. Overall, it is considered that the number of vessels affected in TS is zero compared to 1.6±0.7 in ACS; however, other authors have found stenoses not greater than 50% in 10–21% [21], or even greater than 50% [5,34,125]. Some coronary artery lesions have a chronic morphology with no angiographic evidence of acute complication by virtue of its prevalence in the population at risk, whereas others are acute lesions giving rise to ischemia associated with the TS [95,125]. Angiography has revealed spontaneous coronary artery spasm in 1.4–10% [25,94,126], induced spasm in 4.5–71% [3,11,13] and vasoconstriction in 21–100% [3,21]. Asian individuals are more likely to develop vasospasm, but this likelihood may be due to the widespread use of provocation tests in Japan [127]. Ventriculography shows the same changes as echocardiography (Figure 3).


Takotsubo cardiomyopathy--a clinical review.

Castillo Rivera AM, Ruiz-Bailén M, Rucabado Aguilar L - Med. Sci. Monit. (2011)

Ventriculography image of apical ballooning which shows apical akinesia and basal hyperkinesis.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3539553&req=5

f3-medscimonit-17-6-ra135: Ventriculography image of apical ballooning which shows apical akinesia and basal hyperkinesis.
Mentions: Normality of the epicardial coronary arteries is normally a requirement for the diagnosis of TS [4,7,13,74]. Overall, it is considered that the number of vessels affected in TS is zero compared to 1.6±0.7 in ACS; however, other authors have found stenoses not greater than 50% in 10–21% [21], or even greater than 50% [5,34,125]. Some coronary artery lesions have a chronic morphology with no angiographic evidence of acute complication by virtue of its prevalence in the population at risk, whereas others are acute lesions giving rise to ischemia associated with the TS [95,125]. Angiography has revealed spontaneous coronary artery spasm in 1.4–10% [25,94,126], induced spasm in 4.5–71% [3,11,13] and vasoconstriction in 21–100% [3,21]. Asian individuals are more likely to develop vasospasm, but this likelihood may be due to the widespread use of provocation tests in Japan [127]. Ventriculography shows the same changes as echocardiography (Figure 3).

Bottom Line: The electrocardiographic, echocardiographic, and ventriculographic changes resolve spontaneously over a variable period of time (from days to months).There are a number of pathophysiological theories, none of which has been shown to be definitive, suggesting that all of them may be involved to some extent.The prognosis is generally favourable, and recurrence is very rare.

View Article: PubMed Central - PubMed

Affiliation: Department of Critical Care and Emergency, Intensive Medicine Unit, Jaén Hospital Complex, Jaén, Spain. ana.castillorivera@gmail.com

ABSTRACT
Stress cardiomyopathy is characterised by reversible left ventricular dysfunction. It simulates an acute coronary syndrome (ACS), presenting with precordial pain or dyspnoea, changes of the ST segment, T wave, or QTc interval on electrocardiogram, and raised cardiac enzymes. Typical findings are disturbances of segmental contractility (apical hypokinesia or akinesia), with normal epicardial coronary arteries. The true prevalence is unknown, as the syndrome may be under-diagnosed; it is more common in postmenopausal women. There is usually a trigger in the form of physical or psychological stress. The electrocardiographic, echocardiographic, and ventriculographic changes resolve spontaneously over a variable period of time (from days to months). There are a number of pathophysiological theories, none of which has been shown to be definitive, suggesting that all of them may be involved to some extent. The prognosis is generally favourable, and recurrence is very rare.

Show MeSH
Related in: MedlinePlus