Stress cardiomyopathy goes by many names including takotsubo cardiomyopathy, apical ballooning syndrome, broken heart syndrome, and stress-induced cardiomyopathy.
The patient has transient regional systolic dysfunction of the left ventricle.
Clinically, this mimics a myocardial infarction, but when an angiogram is performed there is no evidence of obstructive coronary artery disease or acute plaque rupture.
The term “takotsubo” is from the Japanese name for an octopus trap, which has a shape that is similar to the systolic apical ballooning appearance of the left ventricle which is seen in the most common form of this disorder.
These patients will present looking very similar to a classic acute coronary syndrome, with chest pain and shortness of breath.
Additionally, according to the International Takotsubo Registry study approximately 7.7% will present with syncope.
Most common in elderly female patients.
EKG is highly variable.
Patients may present with normal ECG up to 11% of the time.
Could have ST/T wave changes, ST elevation, transient LBBB or arrhythmias.
The most characteristic takotsubo ECG feature is a prolongation of QT/QTc
May have elevated troponin and BNP.
Usually will have decreased ejection fraction ~40%
Wall motion abnormalities in one of a few specific patterns:
Apical – Systolic apical ballooning of the LV
Mid-ventricular – Ventricular hypokinesis of the mid-ventricle with relative sparing of the apex
Basal – Hypokinesis of the base and sparing of the mid-ventricle and apex (called reverse or inverted Takotsubo)
Focal – Rare variant with dysfunction of an isolated segment
Always follow ACS/STEMI treatment protocol until this diagnosis is proven.
Monitor the QTc interval and arrhythmia.
Stop QT prolonging medications
If the patient has pump failure and no LVOT obstruction, treat with inotropes like dobutamine and dopamine
If the patient has pump failure and evidence of LVOT obstruction, treat similar to hypertrophic cardiomyopathy
Inotropes may worsen the obstruction.
Treat with beta blockers.
If vasopressors are needed, consider phenylephrine