Takotsubo cardiomyopathy with an unusual pattern of regional left ventricular wall motion abnormalities

Abstract

Sirs: Takotsubo cardiomyopathy, first described in the early 1990s in Japan [ 3], is characterized by a transient dysfunction of the left ventricle with initially, often severely reduced ejection fraction [ 4, 5]. In many patients, it is associated with electrocardiographic changes, elevated myocardial biomarkers and symptoms like chest pain and dyspnoea [ 7]. Thereby, it often mimics an acute coronary syndrome ( ACS) despite angiographic absence of obstructive coronary artery disease. In a recent review of 14 studies with a total of 286 patients [ 4], Takotsubo cardiomyopathy had a prevalence of up to 2.2% in patients with ST- segment elevation ACS. It occurred mostly in women ( 89%) older than 50 years and was often preceded by emotional ( 27%) or physical stress ( 38%). Sympathetic hyperactivity has therefore been proposed as an underlying mechanism [ 8], but the precise pathophysiology is still unkown. Takotsubo cardiomyopathy has also been described as transient apical ballooning syndrome due to the typical pattern of regional wall motion disturbances of the left ventricle. Most patients demonstrate akinesis or dyskinesis of the apex and the adjacent midventricular walls with preserved or hyperkinetic contractile function of the basal left ventricular segments, resembling at end- systole the Tako- tsubo, a Japanese octopus trap with a round bottom and a narrow neck. However, it has also been associated with other patterns of regional left ventricular contractile dysfunction [ 1, 2]. Here we describe a patient with a typical history but an atypical manifestation of Takotsubo cardiomyopathy.