Tako-tsubo cardiomyopathy: The "broken heart syndrome"
Keywords:
MedicineAbstract
Tako-tsubo cardiomyopathy is a recently described clinical entity which classically presents as an acute coronary syndrome. Key features include “ballooning” of the left ventricle, patent coronary arteries, non-specific electrocardiogram changes and elevated cardiac enzymes. This condition clinically mimics acute myocardial infarction and is believed to account for at least 1-2% of patients admitted to hospital with this diagnosis. The typical patient with tako-tsubo cardiomyopathy is a postmenopausal woman presenting with acute onset of chest pain and dyspnoea, who has recently experienced a profoundly stressful physiological or psychological event. Catecholamines are implicated in the pathophysiology of this condition, although their precise role is the subject of much debate. Currently, routine investigations are not specific for tako-tsubo cardiomyopathy and it should be considered as a diagnosis of exclusion. Relative to myocardial infarction, the prognosis of tako-tsubo cardiomyopathy is excellent; the mortality rate is low, fewer than 10% of patients experience a recurrence of the condition and recovery is generally spontaneous with minimal intervention. Herein, the aim of this review is to provide an overview of tako-tsubo cardiomyopathy by examining its pathophysiology and clinical characteristics.
References
1 Dote K, Sato H, Tateishi H, et al. Myocardial stunning due to simultaneous multivessel coronary spasm: a review of 5 cases. J. Cardiol. 1991;21:203-14.
2 Ito K, Sugihara H, Katoh S, Azuma A, Nakagawa M. Assessment of Takotsubo (ampulla) cardiomyopathy using 99mTc-tetrofosmin myocardial SPECT--comparison with acute coronary syndrome. Ann. Nucl. Med. 2003;17(2):115-22.
3 Pilliere R, Mansencal N, Digne F, et al. Prevalence of Tako-Tsubo syndrome in a large urban agglomeration. Am. J. Cardiol. 2006;98:662-5.
4 Elian D, Osherov A, Matetzky S, et al. Left ventricular apical ballooning: not an uncommon variant of acute myocardial infarction in women. Clin. Cardiol. 2006;29:9-12.
5 Rosamond W, Flegal K, Friday G, et al. Heart disease and stroke statistics–2007 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2007;115:e69-e171.
6 Morbidity Analysis for Hospital Discharges in 2007: Section Four. ESRI. http://www.esri.ie/ health_information/latest_hipe_nprs_reports/2007/ Section_IV_2007.pdf
7 Gianni M. et al, Apical Ballooning Syndrome or Tako-tsubo Cardiomyopathy: A Systematic Review. Eur. Heart. J. 2006;27:1523–1529.
8 Prasad A. et al, Apical ballooning syndrome (Tako- Tsubo or stress cardiomyopathy): A mimic of acute myocardial infarction. Am. Heart. J. 2008;155:408-17. 9 Bybee KA, Kara T, Prasad A, et al. Transient left ventricular apical ballooning syndrome: a mimic of ST-segment elevation myocardial infarction. Ann. Intern. Med. 2004;141:858-65.
10 Elesber A, Prasad A, Lennon R, et al. Four-year recurrence rate and prognosis of the apical ballooning syndrome. J. Am. Coll. Cardiol. 2007;50:448-52.
11 Hadase M, Kawasaki T, Asada S, et al. Reverse distribution of Tc-99m tetrofosmin in a patient with “Takotsubo” cardiomyopathy. Clin. Nucl. Med. 2003;58:757-9.
12 Akashi YJ, Tejima T, Sakurada H, et al. Left ventricular rupture associated with Takotsubo cardiomyopathy. Mayo Clin. Proc. 2004;79:821-4.
13 Pisson L, de Vusser P, Mullens W. Apical ballooning in relatives. Heart 2004;90:e67.
14 Zubrinich et al. Tako-tsubo-like cardiomyopathy after EpiPen administration. Internal Med. J. 2008;38:862–867.
15 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.
16 Wantanabe H, Kodama M and Okura Y et al. Impact of Earthquakes on Takotsubo Cardiomyopathy. JAMA. 2005;294(3):305-307.
17 Wittstein IS, Thiemann DR, Lima JA, Baughman KL, Schulman SP, Gerstenblith G, Wu KC, Rade JJ, Bivalacqua TJ, Champion HC. Neurohumoral features of myocardial stunning due to sudden emotional stress. N. Engl. J. Med. 2005;352:539–548.
18 Goldstein DS, Eisenhofer G, Kopin IJ. Sources and significance of plasma levels of catechols and their metabolites in humans. J. Pharmacol. Exp. Ther. 2003;305:800-11.
19 Lyon AR, Rees PS, Prasad S, Poole-Wilson PA, Harding SE. Stress (Takotsubo) cardiomyopathy-a novel pathophysiological hypothesis to explaincatecholamine-induced acute myocardial stunning. Nature 2008;5:22-9.
20 Port JD, Bristow MR. Altered Beta-adrenergic receptor gene regulation and signalling in chronic heart failure. J. Mol. Cell. Cardiol. 2001;33:887–905
21 Heubach JF, Kaumann AJ. Epinephrine activates both Gs and Gi pathways, but norepinephrine activates only the Gs pathway through human beta2- adrenoceptors overexpressed in mouse heart. Mol. Pharmacol. 2004;65:1313–1322.
22 Zamah AM et al. PKA-mediated phosphorylation of the beta 2-adrenergic receptor regulates its coupling to Gs and Gi: demonstration in a reconstituted system. J. Biol. Chem. 2002;277:31249–31256.
23 Kawano H et al. Histological study on the distribution of autonomic nerves in the human heart. Heart Vessels 2003;18:32–39.
24 Mori H et al. Increased responsiveness of left ventricular apical myocardium to adrenergic stimuli. Cardiovasc. Res. 1993;27:192–198.
25 Kyuma M, Tsuchihashi K, Shinshi Y, Hase M, Nakata T, Ooiwa H, et al. Effect of intravenous propranolol on left ventricular apical ballooning without coronary artery stenosis (ampulla cardiomyopathy): three cases. Circ. J. 2002;66:1181-4.
26 Takizawa M et al. A case of transient left ventricular ballooning with pheochromocytoma, supporting pathogenetic role of catecholamines in stress-induced cardiomyopathy or takotsubo cardiomyopathy. Int. J. Cardiol. 2007;114:15–17.
27 Szakacs JE, Cannon A. L-Norepinephrine myocarditis. Am. J. Clin. Pathol. 1958;30:425-34.
28 Morel O et al. Importance of Inflammation and Neurohumoral Activation in Takotsubo Cardiomyopathy. J. Cardiac Failure 2009;15:206-213. 29 Kurisu S, Sato H, Kawagoe T, Ishihara M, Shimatani Y, Nishioka K, et al. Tako-tsubo-like left ventricular dysfunction with ST-segment elevation: a novel cardiac syndrome mimicking acute myocardial infarction. Am. Heart. J. 2002;143:448-55.
30 Mann DL, Kent RL, Parsons B, Cooper G. Adrenergic effects on the biology of the adult mammalian cardiocyte. Circulation 1992;85:790-804.
31 Bolli R, Marban E. Molecular and cellular mechanisms of myocardial stunning. Physiol. Rev. 1999;79:609-34.
32 Lacy CR, Contrada RJ, Robbins ML, et al. Coronary vasoconstriction induced by mental stress (simulated public speaking). Am. J. Cardiol. 1995;75:503-5.
33 Sadamatsu K, Tashiro H, Maehira N, Yamamoto K. Coronary microvascular abnormality in the reversible systolic dysfunction observed after noncardiac disease. Jpn. Circ. J. 2000;64:789-92.
34 Kuriso S et al. Myocardial perfusion and fatty acid metabolism in patients with tako-tsubo like ventricular dysfunction. J. Am. Coll. Cardiol. 2003;41;743-8.
35 Mathew B, Villareal D. Two unusual cases of Takotsubo cardiomyopathy presenting with sudden cardiac death. Am. J. Med. Sci. 2009;337(6):473-5.
36 Kawai S, Kitabatake A, Tomoike H. Guidelines for diagnosis of takotsubo (ampulla) cardiomyopathy. Circ. J. 2007;71(6):990-2
37 Bybee KA, Prasad A. Stress-related cardiomyopathy syndromes. Circulation. 2008;118:397-409.
38 Ogura R, Hiasa Y, Takahashi T 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;67:687–690.
39 Man-Hong Jim, Annie On-On Chan et al. A new ECG criterion to identify takotsubo cardiomyopathy from anterior myocardial infarction: role of inferior leads.
Heart Vessels. 2009;24:124–130.
40 Kurisu S, Inoue I, Kawagoe T, et al. Time course of electrocardiographic changes in patients with Tako- Tsubo syndrome: comparison with acute myocardial infarction with minimal enzymatic release. Circ. J. 2004;68:77-81.
41 Matsuoka K, Okubo S, Fujii E, et al. Evaluation of the arrhythmogenecity of stress-induced “Takotsubo cardiomyopathy” from the time course of the 12- lead surface electrocardiogram. Am. J. Cardiol. 2003;92:230-3.
42 Elesber A, Prasad A, Bybee KA, et al. Transient cardiac apical ballooning syndrome: prevalence and clinical implications of right ventricular involvement. J. Am. Coll. Cardiol. 2006;47:1082-3.
43 Haghi D, Athanasiadis A, Papavassiliu T, et al. Right ventricular involvement in Takotsubo cardiomyopathy. Eur. Heart J. 2006;27:2433-9.
44 Standring S. Gray’s Anatomy: The Anatomical Basis of Clinical Practice (40th Edition). Churchill Livingstone, 2008.
45 Bybee KA, Prasad A, Barsness GW, Lerman A, Jaffe AS, Murphy JG, Wright RS, Rihal CS. Clinical characteristics and thrombolysis in myocardial
infarction frame counts in women with transient left ventricular apical ballooning syndrome. Am. J. Cardiol. 2004;94:343–346.
46 Pfisterer M.E, Battler A and Zaret B.L. Range of normal values for left and right ventricular ejection fraction at rest and during exercise assessed by radionuclide angiocardiography. Eur. Heart J. 1985;6(8):647-655.
47 Sharkey SW; Lesser JR; Menon M et al. Spectrum and significance of electrocardiographic patterns, troponin levels, and thrombolysis in myocardial infarction frame count in patients with stress (tako- tsubo) cardiomyopathy and comparison to those in patients with ST-elevation anterior wall myocardial infarction. Am. J. Cardiol. 2008;101(12):1723-8.
48 Sharkey SW, Lesser JR, Zenovich AG, et al. Acute and reversible cardiomyopathy provoked by stress in women from the United States. Circulation 2005;111:472-9.
49 Regnante R. et al. Clinical Characteristics and Four-Year Outcomes of Patients in the Rhode Island Takotsubo Cardiomyopathy Registry. Am. J. Cardiol. 2009;103:1015–1019.
2 Ito K, Sugihara H, Katoh S, Azuma A, Nakagawa M. Assessment of Takotsubo (ampulla) cardiomyopathy using 99mTc-tetrofosmin myocardial SPECT--comparison with acute coronary syndrome. Ann. Nucl. Med. 2003;17(2):115-22.
3 Pilliere R, Mansencal N, Digne F, et al. Prevalence of Tako-Tsubo syndrome in a large urban agglomeration. Am. J. Cardiol. 2006;98:662-5.
4 Elian D, Osherov A, Matetzky S, et al. Left ventricular apical ballooning: not an uncommon variant of acute myocardial infarction in women. Clin. Cardiol. 2006;29:9-12.
5 Rosamond W, Flegal K, Friday G, et al. Heart disease and stroke statistics–2007 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2007;115:e69-e171.
6 Morbidity Analysis for Hospital Discharges in 2007: Section Four. ESRI. http://www.esri.ie/ health_information/latest_hipe_nprs_reports/2007/ Section_IV_2007.pdf
7 Gianni M. et al, Apical Ballooning Syndrome or Tako-tsubo Cardiomyopathy: A Systematic Review. Eur. Heart. J. 2006;27:1523–1529.
8 Prasad A. et al, Apical ballooning syndrome (Tako- Tsubo or stress cardiomyopathy): A mimic of acute myocardial infarction. Am. Heart. J. 2008;155:408-17. 9 Bybee KA, Kara T, Prasad A, et al. Transient left ventricular apical ballooning syndrome: a mimic of ST-segment elevation myocardial infarction. Ann. Intern. Med. 2004;141:858-65.
10 Elesber A, Prasad A, Lennon R, et al. Four-year recurrence rate and prognosis of the apical ballooning syndrome. J. Am. Coll. Cardiol. 2007;50:448-52.
11 Hadase M, Kawasaki T, Asada S, et al. Reverse distribution of Tc-99m tetrofosmin in a patient with “Takotsubo” cardiomyopathy. Clin. Nucl. Med. 2003;58:757-9.
12 Akashi YJ, Tejima T, Sakurada H, et al. Left ventricular rupture associated with Takotsubo cardiomyopathy. Mayo Clin. Proc. 2004;79:821-4.
13 Pisson L, de Vusser P, Mullens W. Apical ballooning in relatives. Heart 2004;90:e67.
14 Zubrinich et al. Tako-tsubo-like cardiomyopathy after EpiPen administration. Internal Med. J. 2008;38:862–867.
15 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.
16 Wantanabe H, Kodama M and Okura Y et al. Impact of Earthquakes on Takotsubo Cardiomyopathy. JAMA. 2005;294(3):305-307.
17 Wittstein IS, Thiemann DR, Lima JA, Baughman KL, Schulman SP, Gerstenblith G, Wu KC, Rade JJ, Bivalacqua TJ, Champion HC. Neurohumoral features of myocardial stunning due to sudden emotional stress. N. Engl. J. Med. 2005;352:539–548.
18 Goldstein DS, Eisenhofer G, Kopin IJ. Sources and significance of plasma levels of catechols and their metabolites in humans. J. Pharmacol. Exp. Ther. 2003;305:800-11.
19 Lyon AR, Rees PS, Prasad S, Poole-Wilson PA, Harding SE. Stress (Takotsubo) cardiomyopathy-a novel pathophysiological hypothesis to explaincatecholamine-induced acute myocardial stunning. Nature 2008;5:22-9.
20 Port JD, Bristow MR. Altered Beta-adrenergic receptor gene regulation and signalling in chronic heart failure. J. Mol. Cell. Cardiol. 2001;33:887–905
21 Heubach JF, Kaumann AJ. Epinephrine activates both Gs and Gi pathways, but norepinephrine activates only the Gs pathway through human beta2- adrenoceptors overexpressed in mouse heart. Mol. Pharmacol. 2004;65:1313–1322.
22 Zamah AM et al. PKA-mediated phosphorylation of the beta 2-adrenergic receptor regulates its coupling to Gs and Gi: demonstration in a reconstituted system. J. Biol. Chem. 2002;277:31249–31256.
23 Kawano H et al. Histological study on the distribution of autonomic nerves in the human heart. Heart Vessels 2003;18:32–39.
24 Mori H et al. Increased responsiveness of left ventricular apical myocardium to adrenergic stimuli. Cardiovasc. Res. 1993;27:192–198.
25 Kyuma M, Tsuchihashi K, Shinshi Y, Hase M, Nakata T, Ooiwa H, et al. Effect of intravenous propranolol on left ventricular apical ballooning without coronary artery stenosis (ampulla cardiomyopathy): three cases. Circ. J. 2002;66:1181-4.
26 Takizawa M et al. A case of transient left ventricular ballooning with pheochromocytoma, supporting pathogenetic role of catecholamines in stress-induced cardiomyopathy or takotsubo cardiomyopathy. Int. J. Cardiol. 2007;114:15–17.
27 Szakacs JE, Cannon A. L-Norepinephrine myocarditis. Am. J. Clin. Pathol. 1958;30:425-34.
28 Morel O et al. Importance of Inflammation and Neurohumoral Activation in Takotsubo Cardiomyopathy. J. Cardiac Failure 2009;15:206-213. 29 Kurisu S, Sato H, Kawagoe T, Ishihara M, Shimatani Y, Nishioka K, et al. Tako-tsubo-like left ventricular dysfunction with ST-segment elevation: a novel cardiac syndrome mimicking acute myocardial infarction. Am. Heart. J. 2002;143:448-55.
30 Mann DL, Kent RL, Parsons B, Cooper G. Adrenergic effects on the biology of the adult mammalian cardiocyte. Circulation 1992;85:790-804.
31 Bolli R, Marban E. Molecular and cellular mechanisms of myocardial stunning. Physiol. Rev. 1999;79:609-34.
32 Lacy CR, Contrada RJ, Robbins ML, et al. Coronary vasoconstriction induced by mental stress (simulated public speaking). Am. J. Cardiol. 1995;75:503-5.
33 Sadamatsu K, Tashiro H, Maehira N, Yamamoto K. Coronary microvascular abnormality in the reversible systolic dysfunction observed after noncardiac disease. Jpn. Circ. J. 2000;64:789-92.
34 Kuriso S et al. Myocardial perfusion and fatty acid metabolism in patients with tako-tsubo like ventricular dysfunction. J. Am. Coll. Cardiol. 2003;41;743-8.
35 Mathew B, Villareal D. Two unusual cases of Takotsubo cardiomyopathy presenting with sudden cardiac death. Am. J. Med. Sci. 2009;337(6):473-5.
36 Kawai S, Kitabatake A, Tomoike H. Guidelines for diagnosis of takotsubo (ampulla) cardiomyopathy. Circ. J. 2007;71(6):990-2
37 Bybee KA, Prasad A. Stress-related cardiomyopathy syndromes. Circulation. 2008;118:397-409.
38 Ogura R, Hiasa Y, Takahashi T 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;67:687–690.
39 Man-Hong Jim, Annie On-On Chan et al. A new ECG criterion to identify takotsubo cardiomyopathy from anterior myocardial infarction: role of inferior leads.
Heart Vessels. 2009;24:124–130.
40 Kurisu S, Inoue I, Kawagoe T, et al. Time course of electrocardiographic changes in patients with Tako- Tsubo syndrome: comparison with acute myocardial infarction with minimal enzymatic release. Circ. J. 2004;68:77-81.
41 Matsuoka K, Okubo S, Fujii E, et al. Evaluation of the arrhythmogenecity of stress-induced “Takotsubo cardiomyopathy” from the time course of the 12- lead surface electrocardiogram. Am. J. Cardiol. 2003;92:230-3.
42 Elesber A, Prasad A, Bybee KA, et al. Transient cardiac apical ballooning syndrome: prevalence and clinical implications of right ventricular involvement. J. Am. Coll. Cardiol. 2006;47:1082-3.
43 Haghi D, Athanasiadis A, Papavassiliu T, et al. Right ventricular involvement in Takotsubo cardiomyopathy. Eur. Heart J. 2006;27:2433-9.
44 Standring S. Gray’s Anatomy: The Anatomical Basis of Clinical Practice (40th Edition). Churchill Livingstone, 2008.
45 Bybee KA, Prasad A, Barsness GW, Lerman A, Jaffe AS, Murphy JG, Wright RS, Rihal CS. Clinical characteristics and thrombolysis in myocardial
infarction frame counts in women with transient left ventricular apical ballooning syndrome. Am. J. Cardiol. 2004;94:343–346.
46 Pfisterer M.E, Battler A and Zaret B.L. Range of normal values for left and right ventricular ejection fraction at rest and during exercise assessed by radionuclide angiocardiography. Eur. Heart J. 1985;6(8):647-655.
47 Sharkey SW; Lesser JR; Menon M et al. Spectrum and significance of electrocardiographic patterns, troponin levels, and thrombolysis in myocardial infarction frame count in patients with stress (tako- tsubo) cardiomyopathy and comparison to those in patients with ST-elevation anterior wall myocardial infarction. Am. J. Cardiol. 2008;101(12):1723-8.
48 Sharkey SW, Lesser JR, Zenovich AG, et al. Acute and reversible cardiomyopathy provoked by stress in women from the United States. Circulation 2005;111:472-9.
49 Regnante R. et al. Clinical Characteristics and Four-Year Outcomes of Patients in the Rhode Island Takotsubo Cardiomyopathy Registry. Am. J. Cardiol. 2009;103:1015–1019.
Downloads
Published
2010-01-01
How to Cite
Nolan, J., & Gunko, A. (2010). Tako-tsubo cardiomyopathy: The "broken heart syndrome". Trinity Student Medical Journal , 11(1), Page 21–26. Retrieved from https://ojs.tchpc.tcd.ie/index.php/tsmj/article/view/1845
Issue
Section
Reviews
License
Authors retain copyright and grant the journal the right of first publication with the work simultaneously licensed under a Creative Commons Attribution (CC-BY) 4.0 License that allows others to share the work with an acknowledgement of the work’s authorship and initial publication in this journal.
Provided they are the owners of the copyright to their work, authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal’s published version of the work (e.g., post it to an institutional repository, in a journal or publish it in a book), with an acknowledgement of its initial publication in this journal.
