Takotsubo cardiomyopathy: a rare neuro-cardiological entity with its challenges
DOI:
https://doi.org/10.18203/2349-3259.ijct20222963Keywords:
Takotsubo cardiomyopathy, Left ventricular apex, Stress, Myocarditis, PostmenopausalAbstract
Takotsubo cardiomyopathy (TCM) is a type of neuro cardiological disorder that evince as acute but reversible heart failure. On the whole, it occurs by stress-related cardiomyopathy which illustrates the heart-brain connection. It was first discovered in 1990, by a Japanese cardiovascular specialist. That's the beginning of this heart disease in gaining worldwide acceptance as an independent disease entity. TCM is entirely different from acute myocardial infarction as usually occurs in postmenopausal elderly women due to emotional or physical stress. It is characterized by transient hypokinesis of the left ventricular apex. However, there are complications too that need to be addressed. Some reports of serious TCM include hypotension, thrombosis involving LV apex, heart failure, and ventricular rupture. It is also suggested that coronary spasms, myocarditis, and coronary microvascular dysfunction might contribute to the pathogenesis of TCM. But in total, its pathophysiology is unclear. In this review article, we review the pathogenesis and etiology of this rare complex disorder along with its clinical features, findings, challenges in diagnosis, and a comprehensive discussion on the same.
References
Komamura K, Fukui M, Iwasaku T, Hirotani S, Masuyama T. Takotsubo cardiomyopathy: Pathophysiology, diagnosis and treatment. World J Cardiol. 2014;6(7):602-9.
Akashi YJ, Goldstein DS, Barbaro G, Ueyama T. Takotsubo cardiomyopathy: a new form of acute, reversible heart failure. Circulation. 2008;118(25):2754-62.
Sato M, Fujita S, Saito A, Ikeda Y, Kitazawa H, Takahashi M, Ishiguro J, Okabe M, Nakamura Y, Nagai T, Watanabe H. Increased incidence of transient left ventricular apical ballooning (so-calledTakotsubo'cardiomyopathy) after the mid-Niigata Prefecture earthquake. Circulation J. 2006;70(8):947-53.
Amin HZ, Amin LZ, Pradipta A. Takotsubo Cardiomyopathy: A Brief Review. J Med Life. 2020;13(1):3-7.
Gianni M, Dentali F, Grandi AM, Sumner G, Hiralal R, Lonn E. Apical ballooning syndrome or takotsubo cardiomyopathy: a systematic review. Eur Heart J. 2006;27(13):1523-9.
Hurst R, Prasad A, Askew J, Sengupta PP, Tajik AJ. Takotsubo Cardiomyopathy: A Unique Cardiomyopathy With Variable Ventricular Morphology. J Am Coll Cardiol Img. 2010;3(6):641-9.
Parodi G, Del Pace S, Carrabba N, Salvadori C, Memisha G, Simonetti I, Antoniucci D, Gensini GF. Incidence, clinical findings, and outcome of women with left ventricular apical ballooning syndrome. Am J Cardiol. 2007;99:182-5.
Eshtehardi P, Koestner SC, Adorjan P, Windecker S, Meier B, Hess OM, Wahl A, Cook S. Transient apical ballooning syndrome--clinical characteristics, ballooning pattern, and long-term follow-up in a Swiss population. Int J Cardiol. 2009;135:370-5.
Strunk B, Shaw RE, Bull S, Adams J, Baer M, Gershengorn K, Kao A, Keeffe B, Sklar J, Sperling D, et al. High incidence of focal left ventricular wall motion abnormalities and normal coronary arteries in patients with myocardial infarctions presenting to a community hospital. J Invasive Cardiol. 2006;18:376-81.
Wedekind H, Möller K, Scholz KH. Tako-tsubo cardiomyopathy. Incidence in patients with acute coronary syndrome. Herz. 2006;31:339-46.
Bajolle F, Basquin A, Lucron H, Bonnet D. Acute ischemic cardiomyopathy after extreme emotional stress in a child. Congenit Heart Dis. 2009;4:387-90.
Maruyama S, Nomura Y, Fukushige T, Eguchi T, Nishi J, Yoshinaga M, Kawano Y. Suspected takotsubo cardiomyopathy caused by withdrawal of bupirenorphine in a child. Circ J. 2006;70:509-11.
Kurisu S, Inoue I, Kawagoe T, Ishihara M, Shimatani Y, Nakama Y, Kagawa E, Dai K, Ikenaga H. Presentation of Tako-tsubo cardiomyopathy in men and women. Clin Cardiol. 2010;33:42-5.
Patel HM, Kantharia BK, Morris DL, Yazdanfar S. Takotsubo syndrome in African-American women with atypical presentations: a single-center experience. Clin Cardiol. 2007;30:14-8.
Cangella F, Medolla A, De Fazio G, Iuliano C, Curcio N, Salemme L, Mottola G, Agrusta M. Stress induced cardiomyopathy presenting as acute coronary syndrome: Tako-Tsubo in Mercogliano, Southern Italy. Cardiovasc Ultrasound. 2007;5:36.
Bybee KA, Murphy J, Prasad A, Wright RS, Lerman A, Rihal CS, Chareonthaitawee P. Acute impairment of regional myocardial glucose uptake in the apical ballooning (takotsubo) syndrome. J Nucl Cardiol. 2006;13:244-50.
Sharkey SW, Lesser JR, Zenovich AG, Maron MS, Lindberg J, Longe TF, Maron BJ. Acute and reversible cardiomyopathy provoked by stress in women from the United States. Circulation. 2005;111:472-9.
Tsuchihashi K, Ueshima K, Uchida T, Oh-mura N, Kimura K, Owa M, 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;38:11-8.
Dote K, Sato H, Tateishi H, Uchida T, Ishihara M. Myocardial stunning due to simultaneous multivessel coronary spasms: a review of 5 cases. J Cardiol. 1991;21:203-14.
Lyon AR, Rees PS, Prasad S, Poole-Wilson PA, Harding SE. Stress (Takotsubo) cardiomyopathy--a novel pathophysiological hypothesis to explain catecholamine-induced acute myocardial stunning. Nat Clin Pract Cardiovasc Med. 2008;5:22-9.
Padayachee L. Levosimendan: the inotrope of choice in cardiogenic shock secondary to takotsubo cardiomyopathy? Heart Lung Circ. 2007;16(3):S65-70.
Ibanez B, Navarro F, Cordoba M, M-Alberca P, Farre J. Tako-tsubo transient left ventricular apical ballooning: is intravascular ultrasound the key to resolve the enigma? Heart. 2005;91:102-4.
Prasad A, Lerman A, Rihal CS. Apical ballooning syndrome (Tako-Tsubo or stress cardiomyopathy): a mimic of acute myocardial infarction. Am Heart J. 2008;155:408-17.
Previtali M, Repetto A, Panigada S, Camprotondo R, Tavazzi L. Left ventricular apical ballooning syndrome: prevalence, clinical characteristics and pathogenetic mechanism in a European population. Int J Cardiol. 2009;134:91-6.
Kosuge M, Ebina T, Hibi K, Morita S, Okuda J, Iwahashi N, et al. Simple and accurate electrocardiographic criteria to differentiate takotsubo cardiomyopathy from anterior acute myocardial infarction. J Am Coll Cardiol. 2010;55:2514-6.
Ogura R, Hiasa Y, Takahashi T, Yamaguchi K, Fujiwara K, Ohara Y, et al. Specific findings of the standard 12-lead ECG in patients with ‘Takotsubo’ cardiomyopathy: Comparison with the findings of acute anterior myocardial infarction. Circ J. 2003;67:687-90.
Scantlebury DC, Prasad A. Diagnosis of takotsubo cardiomyopathy. Circ J. 2014;78:2129-39.
Sharkey SW, Maron BJ. Epidemiology and clinical profile of takotsubo cardiomyopathy. Circ J. 2014;78:2119-28.
Nguyen TH, Neil CJ, Sverdlov AL, Mahadavan G, Chirkov YY, Kucia AM, et al. N-terminal pro-brain natriuretic protein levels in takotsubo cardiomyopathy. Am J Cardiol. 2011;108:1316-21.
Sharkey SW, Windenburg DC, Lesser JR, Maron MS, Hauser RG, Lesser JN, et al. Natural history and expansive clinical profile of stress (tako-tsubo) cardiomyopathy. J Am Coll Cardiol. 2010;55:333-41.
Hurst RT, Asker JW, Reuss CS, Lee RW, Sweeney JP, Fortuin FD, et al. Transient midventricular ballooning syndrome: a new variant. J Am Coll Cardiol. 2006;48:579-83.
Kohan AA, Yeyati EL, Stefano LD, Dragonetti L, Pietrani M, de Arenaza DP, et al. Usefulness of MRI in takotsubo cardiomyopathy: a review of the literature. Cardiovasc Diagn Ther. 2014;4(2):138-46.
Akashi YJ, Nef HM, Lyon AR. Epidemiology and pathophysiology of Takotsubo syndrome. Nat Rev Cardiol. 2015;12(7):387-97.
Wittstein IS, Thiemann DR, Lima JA, Baughman KL, Schulman SP, Gerstenblith G, Wu KC, Rade JJ, Bivalacqua TJ, Champion HC. Neurohormonal features of myocardial stunning due to sudden emotional stress. N Engl J Med. 2005;352:539-48.
Abraham J, Mudd JO, Kapur NK, Klein K, Champion HC, Wittstein IS. Stress cardiomyopathy after intravenous administration of catecholamines and beta-receptor agonists. J Am Coll Cardiol. 2009;53:1320-5.
Marcovitz PA, Czako P, Rosenblatt S, Billecke SS. Pheochromocytoma presenting with Takotsubo syndrome. J Interv Cardiol. 2010;23:437-42.
Roshanzamir S, Showkathali R. Takotsubo cardiomyopathy a short review. Curr Cardiol Rev. 2013;9:191-6.
Frustaci A, Loperfido F, Gentiloni N, Caldarulo M, Morgante E, Russo MA. Catecholamine-induced cardiomyopathy in multiple endocrine neoplasia: a histologic, ultrastructural, and biochemical study. Chest. 1991;99:382-5.
Ellison GM, Torella D, Karakikes I, Purushothaman S, Curcio A, Gasparri C, et al. Acute beta-adrenergic overload produces myocyte damage through calcium leakage from the ryanodine receptor 2 but spares cardiac stem cells. J Biol Chem. 2007;282:11397-409.
Templin C, Ghadri JR, Dieekmann J, Napp LC, Bataiosu DR, Jaguszewski M, et al. Clinical features and outcomes of Takotsubo (stress) cardiomyopathy. N Engl J Med. 2005;373(10):929-38.
Galiuto L, De Caterina AR, Porfidia A, Paraggio L, Barchetta S, Locorotondo G, et al. Reversible coronary microvascular dysfunction: a common pathogenetic mechanism in apical ballooning ot tako-tsubo syndrome. Eur Heart J. 2010;31:1319-27.
Martin EA, Prasad A, Rihal CS, Lerman LO, Lerman A. Endothelial function and vascular response to mental stress are impaired in patients with apical ballooning syndrome. J Am Coll Cardiol. 2010;56:1840-6.
Uchida Y, Egami H, Uchida Y, Sakurai T, Kanai M, Shirai S, Nakagawa O, Oshima T. Possible participation of endothelial cell apoptosis of coronary microvessels in the genesis of takotsubo cardiomyopathy. Clin Cardiol. 2010;33:371-7.
Ueyama T, Hano T, Kasamatsu K, Yamamoto K, Tsuruo Y, Nishio I. Estrogen attenuates the emotional stress=induced cardiac responses in the animal model of tako-tsubo (ampulla) cardiomyopathy. J Cardiovasc Pharmacol. 2003;42(1):S117-9.
Migliore F, Bilato C, Isabella G, Iliceto S, Tarantini G. Haemodynamic effects of acute intravenous metoprolol in apical ballooning syndrome with dynamic left ventricular outflow tract obstruction. Eur J Heart Fail. 2010;12:305-8.
Cevik C, Nugent K. The role of cardiac autonomic control in the pathogenesis of tako-tsubo cardiomyopathy. Am Heart J. 2008;156:e31.
Spinelli L, Trimarco V, Di Marino S, Marino M, Iaccarino G, Trimarco B. L41Q polymorphism of the G protein coupled receptor kinase 5 is associated with left ventricular apical ballooning syndrome. Eur J Heart Fail. 2010;12:13-6.
Cherian J, Angelis D, Filiberti A, et al. Can takotsubo cardiomyopathy be familial? Int J Cardiol. 2007;121:74-5.
Pison L, De Vusser P, Mullens W. Apical ballooning in relatives. Heart. 2004;90:e67.
Peliccia F, Kaski JC, Crea F, Camici PG. Pathophysiology of Takotsubo Syndrome. Circulation. 2017;135:2426-41.
