The Southern Medical Journal (SMJ) is the official, peer-reviewed journal of the Southern Medical Association. It has a multidisciplinary and inter-professional focus that covers a broad range of topics relevant to physicians and other healthcare specialists.

SMJ // Article

Case Report

A Unique Case of Recurrent Takotsubo Cardiomyopathy

Authors: Himanshu Pathak, MD, Jason Esses, MD, Swati Pathak, MD, Robert Frankel, MD, Gerald Hollander, MD

Abstract

Takotsubo (stress induced) cardiomyopathy is also known as broken heart syndrome or transient left ventricular apical ballooning syndrome. The clinical presentation, which mimics acute myocardial infarction, is preceded by intense emotional or physical stress. Recurrence of apical ballooning syndrome seems to be rare. We present a case of recurrent takotsubo cardiomyopathy precipitated by relatively mild physical stress. There was full recovery with conservative management. This suggests that there are presently unknown patient-specific characteristics that predispose patients to takotsubo cardiomyopathy.


Key Points


* Takotsubo cardiomyopathy presents similarly to acute coronary syndrome.


* The clinical manifestations and echocardiography abnormalities are out of proportion to the degree of elevation in cardiac enzymes.


* Complete recovery is almost a rule and recurrence is rare.


* Its association with physical or emotional stress suggests that this disorder may be caused by a diffuse catecholamine-induced microvascular spasm or dysfunction resulting in myocardial stunning.

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References

1. Cherian J, Angelis D, Filiberti A, et al. Recurrence of stress-induced (takotsubo) cardiomyopathy. Cardiology 2007;108:144–146.
 
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;141:858–865.
 
3. 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;38:11–18.
 
4. Sharkey SW, Lesser JR, Zenovich AG, et al. Acute and reversible cardiomyopathy provoked by stress in women from the United States. Circulation 2005;111:472–479.
 
5. Gianni M, Dentali F, Grandi AM, et al. Apical ballooning syndrome or takotsubo cardiomyopathy: a systematic review. Eur Heart J 2006;27:1523–1529.
 
6. Kurisu S, Sato H, Kawagoe T, et al. Tako-tsubo-like left ventricular dysfunction with ST-segment elevation: a novel cardiac syndrome mimicking acute myocardial infarction. Am Heart J 2002;143:448–455.
 
7. Kushiro T, Saito F, Kusama J, et al. Takotsubo-shaped cardiomyopathy with type I CD36 deficiency. Heart Vessels 2005;20:123–125.