Takotsubo

Takotsubo cardiomyopathy, also known as Takotsubo syndrome or stress-induced cardiomyopathy, is a transient cardiac syndrome characterized by left ventricular systolic dysfunction that mimics acute myocardial infarction but with no obstructive coronary disease. It is often triggered by emotional or physical stress and is more common in postmenopausal women. The term Takotsubo refers to a Japanese octopus pot whose shape resembles the left ventricle during the acute phase.

The condition was first described in Japan in the late 1990s. The proposed mechanism involves a surge of catecholamines with coronary microvascular dysfunction and transient stunning of the myocardium. The classic pattern is apical ballooning, with hypokinesis or akinesis of the mid to distal left ventricle and hyperkinesis of the basal segments, though regional variants exist.

Clinically, Takotsubo cardiomyopathy presents like an acute coronary syndrome: sudden chest pain or dyspnea, electrocardiographic changes (such as ST-segment elevation or T-wave inversion), and modest rises in cardiac biomarkers. Coronary angiography usually shows no obstructive disease. Imaging demonstrates transient left ventricular dysfunction, typically resolving within days to weeks; recovery of wall motion is common.

Diagnosis relies on criteria that exclude pheochromocytoma and myocarditis, demonstrate transient LV dysfunction, and document ST-segment or troponin abnormalities in the absence of obstructive coronary disease. Management is supportive and includes careful treatment of heart failure symptoms and avoidance of potentially harmful inotropes unless necessary. Most patients recover fully, though rare recurrences and complications can occur.