Takotsubo cardiomyopathy: Difference between revisions

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*Mainly supportive as no true lesion and transient
*Mainly supportive as no true lesion and transient
*Treat as STEMI initially
*Treat as STEMI initially
*Anticoagulation may be considered
*Manage Cardiogenic Shock and acute pulmonary edema
*Manage Cardiogenic Shock and acute pulmonary edema
**IVF
**IVF
**With LVOT obstruction
**With LVOT obstruction, avoid volume depletion and vasodilator therapy (like HCM)
**Without LVOT obstruction
**Beta Blockers and ACE Inhibitors are commonly used for Takotsuba
**Beta Blockers and ACE Inhibitors are commonly used for Takotsuba
*Anticoagulation may be considered
**Consider Intra-aortic balloon pump
**Consider Intra-aortic balloon pump



Revision as of 03:49, 2 December 2015

Background

A depicts the left ventricular dilation that occurs in Takotsubo cardiomyopathy compared to a normal heart in B.
  • AKA transient apical ballooning syndrome or stress-induced cardiomyopathy
  • Bulging out of LV apex with preserved function of the base looks like an octopus pot or "tako tsubo" in Japanese
  • 85% of cases caused by stressful event before symptoms (death of loved one, fear, argument, asthma, surgery, stroke, etc.)[1]
    • Proposed mechanisms include vasospasm and abnormal response to catecholamine surge

Clinical Features

Differential Diagnosis

ST Elevation

Cardiomyopathy

Diagnosis

LV apical ballooning during systole
  • Troponin frequently elevated
  • ECG
    • May mimic STEMI
    • Frequently affects the anterior distribution and to a lesser extent inferior distribution
  • Echocardiogram
    • Systolic Dysfunction (with ejection fraction dropping from normal to <25-35%)
    • Reduced contractility not explained by single vessel disease
  • Ventriculography
    • Shows LV ballooning
  • Angiogram
    • No significant coronary blockage to explain LV dysfunction

Management

  • Mainly supportive as no true lesion and transient
  • Treat as STEMI initially
  • Anticoagulation may be considered
  • Manage Cardiogenic Shock and acute pulmonary edema
    • IVF
    • With LVOT obstruction, avoid volume depletion and vasodilator therapy (like HCM)
    • Beta Blockers and ACE Inhibitors are commonly used for Takotsuba
    • Consider Intra-aortic balloon pump

Prognosis

Ejection Fraction returns to normal (at least >50%) in nearly all cases

Disposition

  • Admit for post catheterization care

See Also

External Links

Cardiomyopathy (Main)

References

  1. Sharkey, S., Lesser, J., & Maron, B. (2011). Takotsubo (stress) cardiomyopathy. American Heart Association.