Takotsubo (stress induced) cardiomyopathy

  • MC in postmenopausal women or hx of mental health problem

PATHO

  • Acute stressor ➔ reversible ballooning of left ventricle

    • Activation of sympathetic nervous system or admin of catecholamines/dobuatmine ➔ ↑↑↑ DA, EPI, NE ➔ acute cardiotoxicity or vascular spasm ➔ mid-cavity/apex (MC) ballooning

    • Takotsubo is Japanese for octopus trap (Tako - octopus, Tsubo = pot)

SSX

  • LOOKS LIKE MI - Chest pain

  • HF pulmonary edema ➔ diff breathing

  • Syncope, arrhythmia

DX

  • Get an EKG (first test) and cardiac labs (troponin) because it presents like any other CP

    • ST Elevation usually in V1-V6 and usually without reciprocal ∆'s/depression

  • Coronary angiography because it presents like any other CP and angiography (with PCI) is gold standard in ACS

    • Findings NOT seen in acute MI: normal coronary arteries (no plaque) or non-obstructive coronary disease

  • ECHO (after ACS is r/o) shows apical ballooning/dyskinesia

How they could trick you 🤷‍♂️:

    • They paint the perfect picture (50yo woman presents with SSX after stressful event) and you don't pick EKG as first test

    • After EKG they do angiography that is normal and you don't pick Takotsubo

TX

  • Acute tx: ASA, nitro, β-blockers, heparin, angiography because it presents like any other CP

  • TX HF sx (ACEi, β-blocker) and follow with serial ECHOs to make sure it is resolving

  • If they are unstable and you hear anything about a left ventricular outflow tract obstruction: Use vasopressor - don't use inotropes

    • Inotropes make LVOT obstruction worse