Letters to the Editor

Case Report: Takotsubo Cardiomyopathy in a Recently Widowed Woman



FREE PREVIEW Log in or buy this issue to read the full article. AAFP members and paid subscribers get free access to all articles. Subscribe now.


FREE PREVIEW Subscribe or buy this issue. AAFP members and paid subscribers get free access to all articles.

Am Fam Physician. 2009 Nov 1;80(9):908.

to the editor: Takotsubo cardiomyopathy (also known as stress-induced cardiomyopathy or broken heart syndrome) is a transient condition that occurs most commonly in older women and is triggered by intense emotional or physical stress. It is characterized by transient akinesis or dyskinesis of the apical and midventricular segments of the left ventricle in association with regional wall motion abnormalities.

A 74-year-old black woman with a history of hypertension presented with complaints of weakness and chest pain a few days after the death of her husband whom she had been married to for 35 years. Her examination revealed a blood pressure of 186/88 mm Hg and tachycardia. Electrocardiography (ECG) showed ST-segment elevation in leads V3 through V6, and deep T-wave inversions in leads V3 through V6 and in leads II, III, and aVF. Cardiac enzyme levels were normal. Cardiac catheterization showed no coronary artery stenosis. However, left ventriculography showed apical ballooning in diastole and systole. Echocardiography showed an ejection fraction of 25 percent and ballooning of the left ventricle. The shape of the ventricle resembled that of an octopus trap (called “tako-tsubo” in Japanese), confirming the diagnosis of Takotsubo cardiomyopathy. The patient was treated with beta blockers, angiotensin-converting enzyme (ACE) inhibitors, and aspirin. Two weeks later, repeat echocardiography showed a normal ejection fraction and normal shape of the left ventricle. ECG showed complete resolution of the ST-segment elevation and absence of Q-wave formation.

Takotsubo cardiomyopathy is an increasingly reported syndrome characterized by reversible ballooning of the left ventricular apex in the absence of significant coronary artery disease. The clinical presentation is similar to myocardial ischemia with ECG changes of ST elevation and T-wave inversion but normal coronary angiography. The exact pathology is unclear, but a role for the sympathetic nervous system has been proposed. Management involves a combination of drugs that improve left ventricular systolic dysfunction (e.g., beta blockers, ACE inhibitors, diuretics), as necessary for volume overload. Because this condition is transient, long-term treatment is not required. The prognosis is good with complete left ventricular systolic function recovery typically occurring within weeks.13

Author disclosure: Nothing to disclose.

REFERENCES

1. Tsuchihashi K, Ueshima K, Uchida T, et al. Transient left ventricular apical ballooning without coronary artery stenosis: a novel heart syndrome mimicking acute myocardial infarction. Angina Pectoris-Myocardial Infarction Investigations in Japan. J Am Coll Cardiol. 2001;38(1):11–18.

2. Bybee KA, Kara T, Prasad A, et al. Systematic review: transient left ventricular apical ballooning: a syndrome that mimics ST-segment elevation myocardial infarction. Ann Intern Med. 2004;141(11):858–865.

3. Sharkey SW, Lesser JR, Zenovich AG, et al. Acute and reversible cardiomyopathy provoked by stress in women from the United States. Circulation. 2005;111(4):472–479.

Send letters to Kenneth W. Lin, MD, MPH, Associate Deputy Editor for AFP Online, e-mail: afplet@aafp.org, or 11400 Tomahawk Creek Pkwy., Leawood, KS 66211-2680.

Please include your complete address, e-mail address, and telephone number. Letters should be fewer than 400 words and limited to six references, one table or figure, and three authors.

Letters submitted for publication in AFP must not be submitted to any other publication. Possible conflicts of interest must be disclosed at time of submission. Submission of a letter will be construed as granting the American Academy of Family Physicians permission to publish the letter in any of its publications in any form. The editors may edit letters to meet style and space requirements.



Copyright © 2009 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact afpserv@aafp.org for copyright questions and/or permission requests.

Want to use this article elsewhere? Get Permissions


Article Tools

  • Print page
  • Share this page
  • AFP CME Quiz

Information From Industry

Navigate this Article