Takotsubo Cardiomyopathy in a 22-Year-Old Single-Ventricle Patient.

We report a highly unusual case of a 22-year-old woman with single-ventricle anatomy and a history of Fontan palliation who developed takotsubo cardiomyopathy. To our knowledge, takotsubo cardiomyopathy has not previously been described in a patient with single-ventricle anatomy, or more generally in any patient with congenital heart disease. The patient presented at our clinic for urgent examination after a 2-day history of chest pain that had begun upon the death of her dog. Invasive evaluation was refused by the patient; instead, she underwent electrocardiogram-gated coronary computed tomographic angiography, to rule out obstructive coronary disease. A physician who suspects takotsubo cardiomyopathy in a patient should look for new-onset chest pain and dyspnea coupled with these features: immediate onset of segmental akinesia in the midventricular or apical aspects of the heart, elevation of brain natriuretic peptide level 12 to 24 hours after onset of akinesia, elevation of troponin level 24 to 48 hours after onset, and disappearance of the segmental akinesia a few days after onset.

Recurrent Takotsubo Cardiomyopathy Related to Recurrent Thyrotoxicosis.

Takotsubo cardiomyopathy, or transient left ventricular apical ballooning syndrome, is characterized by acute left ventricular dysfunction caused by transient wall-motion abnormalities of the left ventricular apex and mid ventricle in the absence of obstructive coronary artery disease. Recurrent episodes are rare but have been reported, and several cases of takotsubo cardiomyopathy have been described in the presence of hyperthyroidism. We report the case of a 55-year-old woman who had recurrent takotsubo cardiomyopathy, documented by repeat coronary angiography and evaluations of left ventricular function, in the presence of recurrent hyperthyroidism related to Graves disease. After both episodes, the patient's left ventricular function returned to normal when her thyroid function normalized. These findings suggest a possible role of thyroid-hormone excess in the pathophysiology of some patients who have takotsubo cardiomyopathy.

Two cases of apical ballooning syndrome masking apical hypertrophic cardiomyopathy.

Apical akinesis and dilation in the absence of obstructive coronary artery disease is a typical feature of stress-induced (takotsubo) cardiomyopathy, whereas apical hypertrophy is seen in apical-variant hypertrophic cardiomyopathy. We report the cases of 2 patients who presented with takotsubo cardiomyopathy and were subsequently found to have apical-variant hypertrophic cardiomyopathy, after the apical ballooning from the takotsubo cardiomyopathy had resolved. The first patient, a 43-year-old woman with a history of alcohol abuse, presented with shortness of breath, electrocardiographic and echocardiographic features consistent with takotsubo cardiomyopathy, and no significant coronary artery disease. An echocardiogram 2 weeks later revealed a normal left ventricular ejection fraction and newly apparent apical hypertrophy. The 2nd patient, a 70-year-old woman with pancreatitis, presented with chest pain, apical akinesis, and a left ventricular ejection fraction of 0.39, consistent with takotsubo cardiomyopathy. One month later, her left ventricular ejection fraction was normal; however, hypertrophy of the left ventricular apex was newly noted. To our knowledge, these are the first reported cases in which apical-variant hypertrophic cardiomyopathy was masked by apical ballooning from stress-induced cardiomyopathy.

Inverted Takotsubo cardiomyopathy and the fundamental diagnostic role of echocardiography.

Takotsubo cardiomyopathy is characterized by the development of transient focal wall-motion abnormalities that involve the apical and midventricular segments, in the absence of obstructive coronary artery disease. A variant, inverted takotsubo cardiomyopathy, was described in 2010. We report 3 cases in which each patient's transthoracic echocardiogram revealed the characteristic basal and midventricular segmental akinesis of this variant. This pattern is not associated with coronary artery distribution, and it therefore can be differentiated from coronary artery disease with the use of echocardiography, by evaluating the distribution and temporal changes of akinetic areas.

Left anterior descending coronary artery stenosis: in a patient with takotsubo cardiomyopathy.

Takotsubo cardiomyopathy is characterized by chest pain, electrocardiographic abnormalities such as ST-segment elevation or depression, and elevated cardiac enzyme levels. Left ventriculography reveals transient akinesis of the involved segment of the myocardial wall (usually the left ventricular apex) and compensatory hyperkinesis of the noninvolved myocardium, which appears as apical ballooning during systole. Existing criteria for the diagnosis of takotsubo cardiomyopathy include the absence of obstructive coronary artery disease. Indeed, previous investigators have found incidental stenosis in only a minority of patients.Herein, we present the unusual case of an 84-year-old woman who sustained 4 episodes of takotsubo cardiomyopathy in 18 years. At the time of the initial episode, coronary angiography revealed no substantial stenosis. Concomitant with the 2nd episode, stenosis in the 1st obtuse marginal branch was treated with stenting. No new lesions were apparent after the patient's 3rd presentation, and the previously placed stent was patent. During the 4th (current) presentation, we detected and percutaneously treated severe stenoses in the patient's left anterior descending coronary artery and 2nd obtuse marginal branch.Although this report is of a single patient only, it definitively illustrates that severe coronary artery disease can occur in patients who have takotsubo cardiomyopathy. We recommend the thorough evaluation of possible coronary artery disease in high-risk patients, even upon the strong clinical suspicion of takotsubo cardiomyopathy.

Cardiomiopatia de Takotsubo: Um diagnóstico diferencial da síndrome coronariana aguda: revisão de literatura / Takotsubo cardiomyopathy: a differential diagnosis of the acute coronary syndrome: review of the literature

A cardiomiopatia de Takotsubo, também conhecida como síndrome do balonamento apical transitório do ventrículo esquerdo, foi recentemente descrita no Japão, frequentemente desencadeada por intenso estresse, que apresenta características clínicas, eletrocardiográficas e laboratoriais semelhantes à síndrome coronariana aguda. A realização de um estudo hemodinâmico é, portanto, crucial para sua confirmação diagnóstica, desde que a abordagem terapêutica do infarto agudo do miocárdio é diferente da cardiomiopatia de Takotsubo. O objetivo deste artigo é esclarecer a fisiopatologia, diagnóstico e tratamento dessa entidade nosológica. Presume-se que 1 a 2% dos diagnósticos iniciais de síndrome coronariana aguda sejam cardiomiopatia de Takotsubo, que só é confirmada após a realização de cineangiocoronariografia e ventriculografia. A sua fisiopatologia permanece indefinida, mas sabe-se que deve ser tratada diferentemente do infarto agudo do miocárdio e seu prognóstico é mais favorável.

Takotsubo cardiomyopathy, also known as transient apical ballooning syndrome of the left ventricle, was recently described in Japan, often triggered by intense stress, which presents clinical, electrocardiographic and laboratory findings similar to acute coronary syndrome. The realization of a hemodynamic study is therefore crucial for diagnostic confirmation, since the therapeutic approaches to acute myocardial infarction is different from Takotsubo cardiomyopathy.The aim of this paper is to clarify the pathophysiology, diagnosis and treatment of this illness. It is assumed that 1-2% of the initial diagnosis of acute coronary syndrome are Takotsubo cardiomyopathy, which is confirmed only after coronary angiography and ventriculography are performed. Its pathophysiology remains unclear, but it is known it must to be treated differently from acute myocardial infarction and its prognosis is more favorable.