Biventricular involvement in transient apical ballooning syndrome

Department of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany.
International journal of cardiology (Impact Factor: 4.04). 02/2008; 133(2):e79-80. DOI: 10.1016/j.ijcard.2007.11.034
Source: PubMed


Transient apical ballooning syndrome (Takotsubo cardiomyopathy) is an acute cardiac syndrome mimicking ST-elevation myocardial infarction. It is characterized by ventricular wall motion abnormalities confined to the apical regions of the left ventricle. Here we describe an 80-year old woman presenting with acute shortness of breath. Echocardiography demonstrated left and right ventricular apical akinesia and basal hyperkinesia. Cardiac catheterisation disclosed minimal atherosclerotic changes of the coronary arteries. Both symptoms and echocardiographic findings resolved completely within one week.

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    ABSTRACT: Takotsubo cardiomyopathy is an important differential diagnosis of acute coronary syndrome. It is characterized by normal (or near-normal) coronary arteries, regional wall motion abnormalities that extend beyond a single coronary vascular bed, and often, a precipitating stressor. Variants of the classical left ventricular apical ballooning, including mid- or basal left ventricular wall motion abnormalities, are increasingly recognized. Takotsubo cardiomyopathy is not rare, and heightened awareness of this unique cardiomyopathy likely will lead to a higher reported incidence. Diagnosis of takotsubo cardiomyopathy has important implications for clinical management at presentation and afterward. The long-term prognosis is generally favorable; however, a small subset has potentially life-threatening complications during the initial presentation. The pathophysiologic mechanism is unknown, but catecholamine excess likely has a central role.
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    ABSTRACT: Takotsubo cardiomyopathy is defined as acute chest pain during stressful incidents which is associated with ST-segment abnormalities and/or increased serum troponin levels. There is also regressive systolic dysfunction which is usually localized in the apical and medial left ventricles but there are no significant coronary artery lesions. The ventricular asynergy is also described in the right ventricle but is less common. Almost all the patients are women. The onset of this disease is typically triggered by an acute emotional or stress event or by an accumulation of trivial and repetitive stresses. The etiology of this syndrome remains unclear. Myocardial ischemia and reperfusion due to microvascular spasm, aborted myocardial infarction and related no-reflow phenomenon have been proposed as inducers of Takotsubo cardiomyopathy. The temporal relationship between the stressful event and the triggering of the clinical syndrome as well as the report of elevated catecholamine plasma levels during the acute phase suggest a possible involvement of the sympathetic nervous system. A smaller left ventricular size and hormonal disturbances in women may also play a role.
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