Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF Listen ++ For further information, see CMDT Part 10-45: Stress Cardiomyopathy + Key Features Download Section PDF Listen +++ +++ Essentials of Diagnosis ++ Occurs after a major catecholamine discharge Acute chest pain or shortness of breath Predominately affects postmenopausal women Presents like an acute anterior myocardial infarction, but coronaries normal at cardiac catheterization Imaging reveals apical left ventricular (LV) ballooning due to anteroapical stunning of the myocardium Most patients recover completely +++ General Considerations ++ LV apical ballooning Follows a high catecholamine surge The resulting shape suggests a rounded ampulla form similar to a Japanese octopus pot (tako-tsubo pot) Mid-ventricular ballooning has also been described The myocardial stunning that occurs does not follow the pattern suggestive of coronary ischemia Has been described following some stressful event, such as Hypoglycemia Lightning strikes Earthquakes Postventricular tachycardia Alcohol withdrawal Surgery Hyperthyroidism Stroke Severe emotional stress ("broken-heart syndrome") Virtually any event that triggers excess catecholamines has been implicated Pericarditis and even tamponade have been described in isolated cases Recurrences have been described + Clinical Findings Download Section PDF Listen +++ ++ Symptoms are similar to any acute coronary syndrome Typical angina Dyspnea Arrhythmias Syncope (rare) + Diagnosis Download Section PDF Listen +++ +++ Laboratory Tests ++ Initial cardiac enzymes are positive but often taper quickly +++ Imaging Studies ++ Chest radiograph either normal or shows pulmonary congestion MRI hyperenhancement studies reveal no long-term scarring in almost all cases +++ Diagnostic Studies ++ ECG reveals ST segment elevations Deep anterior T wave inversion that gradually resolve over time Echocardiogram reveals LV apical dyskinesia usually not consistent with any particular coronary distribution Urgent cardiac catheterization reveals LV apical ballooning in association with normal coronary arteries + Treatment Download Section PDF Listen +++ ++ Immediate therapy is similar to any acute myocardial infarction Long-term therapy depends on whether LV dysfunction persists Most patients receive aspirin, beta-blockers, and angiotensin-converting enzyme (ACE) inhibitors until the LV fully recovers Use of ACE inhibitors or angiotensin receptor blockers but not beta-blockers has been associated with improved long-term survival + Outcome Download Section PDF Listen +++ +++ Complications ++ The rate of severe in-hospital complications, including shock and death, are similar to those with an acute coronary syndrome Physical triggers, acute neurologic or psychiatric disease, high troponin levels and a low EF are independent predictors of in-hospital complications Men appear to be at higher risk for major adverse cardiac and cerebrovascular events during the first 30 days following hospitalization +++ Prognosis ++ Mortality reported during the acute phase in hospitalized patients is approximately 4–5%; this figure is comparable to that of ST-segment-elevation myocardial infarction in the era of primary percutaneous coronary interventions Recovery is expected in most cases after a period of weeks to months At times, LV function recovers in a few days Approximately 10% of patients will have cardiac and neurologic adverse outcomes over the next year +++ When to Refer ++ All patients with an acute coronary syndrome should be urgently seen by a cardiologist for further evaluation and monitored until resolution of the ventricular dysfunction + References Download Section PDF Listen +++ + +Sharkey SW et al. Natural history and expansive clinical profile of stress (tako-tsubo) cardiomyopathy. J Am Coll Cardiol. 2010 Jan;55(4):333–41. [PubMed: 20117439] + +Templin C et al. Clinical features and outcome of takotsubo (stress) cardiomyopathy. N Engl J Med. 2015 Sep 3;373(10):929–38. [PubMed: 26332547] + +Tornvall P et al. A case-control study of the risk markers and mortality in Takotsubo stress cardiomyopathy. J Am Coll Cardiol. 2016 Apr 26;67(16):1931–6. [PubMed: 27102508]