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Transient Stress Cardiomyopathy Updated 4/2011

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BASICS

  • Description
  • Epidemiology
  • Risk Factors
  • Pathophysiology
  • Associated Conditions

DIAGNOSIS

  • Signs and Symptoms
  • Tests
  • Differential Diagnosis

TREATMENT

  • Medication (Drugs)
  • Additional Treatment
  • In-patient Considerations

Ongoing Care

  • Follow-Up Recommendations
  • Prognosis
The following is an excerpt....
BASICS
Description
  • Transient stress cardiomyopathy (TSC) is a unique cause of reversible left ventricular (LV) dysfunction with a clinical presentation indistinguishable from the acute coronary syndromes, particularly ST-segment elevation myocardial infarction (MI).
  • Typically, the patient is a postmenopausal woman who presents with acute chest pain or dyspnea after an identifiable “trigger” (i.e., an acute emotional or physiologic stressor).
  • 1st reported by authors from Japan (1,2), TSC was known initially as the Takotsubo syndrome because the typical LV morphology (i.e., apical ballooning) resembled that of a Japanese octopus trap, or takotsubo.
  • Synonym(s) (3): Takotsubo cardiomyopathy; Apical ballooning syndrome; Stress cardiomyopathy; Broken heart syndrome; Ampulla cardiomyopathy
  • Presenting clinical features include:
    • Chest symptoms and/or dyspnea
    • ECG changes ...

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Morphologic features of the main types of cardiomyopathies. The normal geometry of the LV is shown. In comparison, there is enlargement and dilatation of the LV in DCM. In HCM, there is marked thickening of the LV wall, often asymmetric, with the septum being even thicker than the free wall of the LV. In restrictive cardiomyopathy (RCM), the ventricular wall may be normal, hypertrophic, or slightly dilated, but the main feature is that the restriction to diastolic compliance of the ventricle is intrinsic to the ventricle. This occurs by involvement of the endocardium or more commonly by infiltration of the interstitial space with excess collagen, amyloid, or granulomata and their ensuing fibrosis. Abbreviations: EDV, end-diastolic volume; ESV, end-systolic volume; EF, ejection fraction; Mass, ventricular mass; Failure, mode of failure, systolic versus diastolic.Credit: Topol EJ, Califf RM, etal. Textbook of Cardiovascular Medicine, 3rd Edition. Philadelphia: Lippincott Williams & Wilkins, 2006.
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