Takotsubo Cardiomyopathy

Exam Cram

• Moa: severe emotion causing catecholamine release causes apical reduced contraction, across multiple coronary artery territories,

• ECG: ST changes across multiple ischaemic territories; Troponin- raised,

• Diagnosis: ECHO or coronary angiogram,

• Management supportive, dependent on whether left ventricular outflow obstruction.

Outline

Background

• Commonly referred to as 'broken heart syndrome', first cited in Japan of cardiac abnormalities post acute severe emotional distress

Assessment

History

• Chest pain, pre-syncope

• Recent significant emotional event- bereavement, relationship breakup

Examination

• Emotionally labile

Investigations

• ECG- ischaemic changes across multiple vascular territories

• Troponin- often mildly raised

• ECHO or coronary angiogram- dysfunction across multiple vascular territories

Diagnosis

• Diagnostic criteria: (2/2)

  1. Cardiac symptoms 

  2. Dysfunction across multiple vascular territories on ECHO or Coronary Angiogram

• Differentials: NSTEMI, Pericarditis , Acute stress reaction, Coronary Artery Spasm

• Classification: apical is most common

Management

1. Supportive Care

2. Complications

   1. LV thrombus: anticoagulation

   2. LV outflow obstruction: betablockers

Med Reg Notes

Differentials

NSTEMI

These patients are often treated as a NSTEMI acutely until ECHO/ angiogram is done. This is because they have chest pain with raised troponin and ECG changes. Distinguishing feature: ECG changes are across multiple vascular territories in Takasubo. 

Coronary Artery Vasospasm

Differential to differentiate in MCQ as this also presents with chest pain after an emotional event, ECG changes and raised troponin. The ECG changes are within one vascular territory unlike Takasubo. The coronary angiogram is normal, evidence against being an NSTEMI. 

History

Named after the Japanese octopus trap that shuts at the top but the apex doesn't contract. 

Most common type is apical- where the heart's apex doesn't contract. 

Anecdotally, commonly reported that in elderly couples, if one individual dies, their partner often dies within quick succession. It has been hypothesised Takotsubo could be a mechanism. 

Written 2024