Stress-induced (takotsubo) cardiomyopathy
Takotsubo (stress) cardiomyopathy is transient left ventricular systolic dysfunction, classically apical ballooning, triggered by emotional or physical stress and mimicking acute myocardial infarction, predominantly in postmenopausal women. Diagnosis requires the characteristic wall-motion pattern with nonobstructive coronaries and recovery over weeks, and treatment is supportive heart-failure care during the reversible phase.
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What this article covers
- Overview
Definition: takotsubo (stress) cardiomyopathy is transient regional left ventricular systolic dysfunction, classically apical ballooning, provoked by acute stress and not explained by obstructive coronary disease.
- Epidemiology
Predominantly postmenopausal women, who make up the large majority of cases.
- Risk factors
Postmenopausal female sex. Acute emotional or physical stressor, including acute medical illness and neurologic catastrophe (for example subarachnoid hemorrhage).
- Pathophysiology
Catecholamine surge: intense sympathetic activation causes catecholamine-mediated myocardial stunning.
- Clinical features
Acute chest pain and dyspnea: an ACS-like presentation shortly after a stressor.
- Differential diagnosis
Acute myocardial infarction: the principal mimic, with obstructive coronary disease and a wall-motion abnormality confined to one coronary territory, unlike the trans-territorial ballooning of takotsubo (STEMI).
- Diagnosis
Establish with the characteristic transient wall-motion pattern, nonobstructive coronaries, and recovery: the diagnostic basis is transient regional left ventricular dysfunction (classically apical…
- Management
First-line, supportive heart-failure care during the reversible phase: treat congestion with a loop diuretic (furosemide 20 to 40 mg PO, titrated) and manage acute heart failure; provide oxygen and monitoring.
- Complications
Acute heart failure and cardiogenic shock.
- Prognosis
Generally good with recovery of ventricular function over days to weeks.
- Prevention
Manage psychological and physical stressors and treat catecholamine excess.
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