Content Update: Stress Cardiomyopathy and Takotsubo Syndrome February 2021
Stress cardiomyopathy and its commonest form, Takotsubo Syndrome, is acute and transient left ventricular systolic and diastolic dysfunction after a stressful emotional or physical event. Common presenting symptoms are chest pain, dyspnea, and dizziness. ECG abnormalities can mimic STEMI. Diagnosis is confirmed by echocardiography and by lack of culprit vessel involvement on coronary arteriography. See full discussion below under the section 'Cardiomyopathies with Systolic and Diastolic Dysfunction.'
The term cardiomyopathy describes a heterogeneous group of diseases that directly alter cardiac structure, impair myocardial function, or alter myocardial electrical properties. Discoveries in molecular genetics and the description of (ion) channelopathies as diseases have prompted periodic revisions of definitions and classifications of cardiomyopathies. The MOGE(S) classification is the most recently proposed and describes the morphofunctional phenotype (M), organ(s) involvement (O), genetic inheritance pattern (G), etiology (E; which includes genetic defect or underlying disease), and functional status (S).1,2 In simple terms, primary cardiomyopathies are diseases that solely or predominantly involve the myocardium and are usually familial in origin; the most common disorders are listed in Table 55-1. Secondary cardiomyopathies include heart muscle diseases associated with specific systemic disorders. Secondary cardiomyopathies often present with morphofunctional phenotypes and hemodynamic findings similar to those of the dilated or restrictive forms of cardiomyopathy. The most common causes of secondary cardiomyopathies are listed in Table 55-2. As a group, cardiomyopathies are the third most common form of cardiac disease encountered in the United States, following coronary (ischemic) heart disease and hypertensive heart disease. Hypertrophic cardiomyopathy is the second most common cause of sudden cardiac death in the adolescent population and the leading cause of sudden death in competitive athletes.3
TABLE 55-1The Primary Cardiomyopathies ||Download (.pdf) TABLE 55-1 The Primary Cardiomyopathies
Arrhythmogenic right ventricular cardiomyopathy/dysplasia
Left ventricular noncompaction
Conduction system disease
Mixed (genetic and nongenetic)
Myocarditis (inflammatory cardiomyopathy)
Stress (takotsubo) cardiomyopathy
TABLE 55-2Common Causes of Secondary Cardiomyopathies ||Download (.pdf) TABLE 55-2 Common Causes of Secondary Cardiomyopathies
Nutritional deficiency (thiamine, selenium)
Endocrine (diabetes mellitus, hypothyroidism, hyperthyroidism)
Electrolytic disturbance (hypophosphatemia, hypocalcemia)
An in-depth discussion of each of the primary familial and secondary cardiomyopathies is beyond the scope of this chapter, and emergency providers are unlikely to make a specific diagnosis in the ED. This chapter discusses selected cardiomyopathies (Table 55-3). Arrhythmogenic ventricular cardiomyopathy is discussed in Chapter 130, “Syncope, Dysrhythmias, and ECG Interpretation in Children.” The cardiomyopathies usually present with signs ...