3. chest pain
ST-segment elevation
elevated cardiac
enzyme levels
There is no significant coronary
artery stenosis, but there is
ventricular apical ballooning.
3
4. Modified Mayo Clinic criteria for diagnosis are
× Transient hypokinesis, dyskinesis or akinesis of
the left ventricular middle segments, with or
without apical involvement.
× Absence of obstructive coronary disease, absence
of angiographic evidence of acute plaque rupture.
× New ECG abnormalities: ST-segment elevation
or/and T-wave inversion.
× Moderate elevation in the cardiac troponin level.
× Absence of pheochromocytoma or myocarditis.
4
5. Patients with Takotsubo
cardiomyopathy are found
to shift toward the glucose
pathway despite relatively
normal myocardial perfusion
and lack of ischemia in LV
segments.
5
8. 8
Learning of a death of a loved one!
Bad financial news!
Legal problems!
Natural disasters!
Motor vehicle collisions!
Exacerbation of a chronic medical illness!
Newly diagnosed, significant medical condition!
Surgery!
Intensive care unit stay!
Use of or withdrawal from illicit drugs!
9. Epidemiology
9
Mean patient
age is 67
years.
Nearly 90% of
reported
cases involve
postmenopausal
women.
57.2% Asian,
40%
Caucasian
2.8% other
races
10. Nearly 95% of patients
experiencing complete recovery
within 4-8 weeks.
Complications occure in 20% of
patients.
Prognosis
10
11. Complications
Left heart failure
with or without
pulmonary
edema!
Cardiogenic
shock!
LV outflow
obstruction!
11
Mitral
regurgitation!
Ventricular
arrhythmias!
LV mural
thrombus
formation!
LV free-wall rupture!Death!
13. Symptoms
Preceding emotionally or physically stressful trigger
event occurr in two thirds of patients.
The peak occurrence for acute coronary syndrome is
during the morning hours.
Takotsubo cardiomyopathy events are most prevalent
in the afternoon when stressful triggers are more likely
to take place.
13
17. Treatment
It is usually treated in
emergency department as
acute coronary syndrome.
After the initial treatment,
cardiologist should
continue to treat these
patients: beta blockers,
anticoagulation if there is
LV thrombus.
17
