II. Epidemiology

  1. Ages 50 to 70 most commonly affected
  2. Primarily in women (95% of cases)

III. History

  1. Initially described in Japan (1990)
  2. Takotsuba is Japanese for a ceramic octopus trap (which resembles the heart on Echocardiogram)

IV. Pathophysiology

  1. Postulated the cause a Catecholamine surge that results in heart muscle injury and a drop in contractility
  2. Transient with often a full recovery without significant residual Cardiomyopathy by 2 weeks

V. Risk Factors

  1. Major stressors (85%-89% report a stressful event in the preceding 12 hours)
  2. Stress examples
    1. Emotional stressors (e.g. fear, grief, anger)
    2. Physical stressors (e.g. Cerebrovascular Accident)
    3. General Surgery
    4. Chemotherapy
    5. Exogenous Catecholamines such as beta agonists (e.g. Albuterol, Phenylephrine)

VII. Signs

  1. May present with Cardiogenic Shock or lethal arrhythmia (e.g. VT/VF, PEA)

VIII. Labs

  1. Serum Troponin
    1. Frequently increased

IX. Diagnostics

  1. Electrocardiogram
    1. May mimic ST Elevation Myocardial Infarction
    2. May demonstrate contiguous lead ST Elevation with reciprocal changes
      1. Frequently affects the anterior distribution and to a lesser extent inferior distribution
  2. Echocardiogram
    1. Acute, severe Systolic Dysfunction (with ejection fraction dropping from normal to <25-35%)
    2. Echocardiogram demonstrates reduced contractility not explained by single vessel disease
  3. Angiogram
    1. No occlusive vascular disease identified to explain the event

X. Management

  1. Supportive care
  2. Start by treating as Acute Coronary Syndrome and exclude STEMI
  3. Manage arrhythmias as needed
  4. Manage Cardiogenic Shock and acute pulmonary edema
    1. See Cardiogenic Shock for emergent management
    2. Beta Blockers and ACE Inhibitors are commonly used for Takotsuba
    3. Anticoagulation may be considered
    4. Consider Endotracheal Intubation
    5. Consider Intra-aortic balloon pump

XI. Prognosis

  1. Ejection Fraction returns to normal (at least >50%) in nearly all cases (100% in the Sharkey study)
  2. Mortality 2% during hospitalization
  3. Recurrence in 5-6%

XII. References

  1. Hochman and Patel in Herbert (2015) EM:Rap 15(1): 4-6
  2. Sharkey (2010) J Am Coll Cardiol 55(4): 333-41 [PubMed]

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Ontology: Stress induced cardiomyopathy (C1719472)

Concepts Disease or Syndrome (T047)
ICD10 I51.81
English Stress induced cardiomyopathy

Ontology: Takotsubo Cardiomyopathy (C1739395)

Definition (MSH) A transient left ventricular apical dysfunction or ballooning accompanied by electrocardiographic (ECG) T wave inversions. This abnormality is associated with high levels of CATECHOLAMINES, either administered or endogenously secreted from a tumor or during extreme stress.
Definition (NCI) A rare disorder characterized by transient left ventricular wall systolic dysfunction, resulting in apical ballooning appearance, chest pain, and ST segment elevation.
Concepts Disease or Syndrome (T047)
MSH D054549
ICD9 429.83
ICD10 I51.81
SnomedCT 441541008
English Tako-Tsubo cardiomyopathy, Tako tsubo Cardiomyopathy, Tako-tsubo Cardiomyopathy, Tako-tsubo Syndrome, Syndromes, Tako-tsubo, Takotsubo Syndrome, Syndrome, Tako-tsubo, Cardiomyopathy, Takotsubo, Tako tsubo Syndrome, Tako-tsubo Syndromes, Cardiomyopathy, Tako-tsubo, Apical ballooning syndrome, Takotsubo syndrome (diagnosis), Broken heart syndrome, Takotsubo cardiomyopathy, Stress cardiomyopathy, Takotsubo cardiomyopathy (disorder), Left ventricular ballooning syndrome, Takotsubo Cardiomyopathy, Takotsubo Cardiomyopathy [Disease/Finding], Broken Heart Syndrome, Apical Ballooning Syndrome, Stress Cardiomyopathy, Left Ventricular Apical Ballooning Syndrome, Cardiomyopathy, Stress, Syndrome, Apical Ballooning, Syndrome, Broken Heart, Transient Apical Ballooning Syndrome, Syndromes, Broken Heart, Takotsubo syndrome
Dutch Tako Tsubo-cardiomyopathie, stress-cardiomyopathy, apicaal ballooning-syndroom, Takotsubo-syndroom, gebroken-hartsyndroom
French Cardiomyopathie Tako-Tsubo, Cardiomyopathie provoquée par le stress, Syndrome de ballonnement apical, Syndrome du tako-tsubo, Ballonisation apicale transitoire du ventricule gauche, Syndrome de ballonisation apicale transitoire du ventricule gauche, Syndrome de takotsubo, Cardiomyopathie de tako-tsubo, Syndrome de tako-tsubo, Syndrome des coeurs brisés
German Stress-Kardiomyopathie, apical ballooning, Tako-Tsubo-Kardiomyopathie, Takotsubo-Syndrom, Takotsubo-Kardiomyopathie, Tako-Tsubo-Syndrom, Syndrom des gebrochenen Herzens
Italian Cardiomiopatia da stress, Cardiomiopatia Tako-Tsubo, Sindrome di Takotsubo, Sindrome del cuore infranto, Cardiomiopatia di Takotsubo, Sindrome del cuore spezzato
Portuguese Cardiomiopatia de Tako-Tsubo, Stress cardiomiopático, Cardiomiopatia de Takotsubo, Síndrome de Takotsubo, Síndrome de balonismo apical, Síndrome de coração dilacerado
Spanish Cardiomiopatía por estrés, Cardiomiopatía Tako-Tsubo, Síndrome "takotsubo", Síndrome de balonamiento apical, Cardiomiopatía de Takotsubo, Síndrome del corazón roto, miocardiopatía de takotsubo, miocardiopatía de takotsubo (trastorno), miocardiopatía por estrés, Síndrome del Corazón Roto
Japanese ストレス心筋症, ストレスシンキンショウ, タコツボガタシンキンショウ, たこつぼ症候群, 心尖部バルーン化症候群, シンセンブバルーンカショウコウグン, タコツボショウコウグン, ショウシンショウコウグン, 傷心症候群, タコツボ型心筋症, タコ壺型心筋症, 蛸壷型心筋症, 心筋症-たこつぼ型, たこつぼ型心筋障害, たこ壺型心筋障害, たこつぼ型心筋症, タコツボ型心筋障害, タコ壺型心筋障害
Finnish Takotsubon oireyhtymä
Russian КАРДИОМИОПАТИЯ ТАКОТСУБО, KARDIOMIOPATIIA TAKOTSUBO
Czech Syndrom zlomeného srdce, Takocubův syndrom, Stresová kardiomyopatie, Tako-Cubova kardiomyopatie, Syndrom apikálního nabývání, takotsubo kardiomyopatie, akutní vydutí levé komory, stresová kardiomyopatie, stresem navozené omráčení myokardu, tako-tsubo kardiomyopatie, reverzibilní stresová kardiomyopatie, syndrom zlomeného srdce
Swedish Takotsubokardiomyopati
Polish Zespół takotsubo, Kardiomiopatia stresowa, Zespół tako-tsubo, Kardiomiopatia tako-tsubo, Kardiomiopatia takotsubo
Hungarian Apicalis ballonozó syndroma, Tako-Tsubo cardiomyopathia, Stress cardiomyopathia, Takotsubo-syndroma, Összetört szív syndroma
Norwegian Takotsubo kardiomyopati, Stressindusert hjertesvikt, Tako-tsubo syndrom, Venstre ventrikkel med apikalt ballongsyndrom