- Case report
- Open Access
- Open Peer Review
Takotsubo cardiomyopathy in a Caucasian Italian woman: Case report
© Lisi et al; licensee BioMed Central Ltd. 2007
- Received: 24 March 2007
- Accepted: 06 April 2007
- Published: 06 April 2007
Takotsubo cardiomyopathy is an acute cardiac syndrome characterized by transient LV regional wall motion abnormalities (with peculiar apical ballooning appearance), chest pain or dyspnea, ST-segment elevation and minor elevations of cardiac enzyme levels
A 68-year-old woman was admitted to the Emergency Department because of sudden onset chest pain occurred while transferring her daughter, who had earlier suffered a major seizure, to the hospital. The EKG showed sinus tachycardia with ST-segment elevation in leads V2–V3 and ST-segment depression in leads V5–V6, she was, thus, referred for emergency coronary angiography. A pre-procedural transthoracic echocardiogram revealed regional systolic dysfunction of the LV walls with hypokinesis of the mid-apical segments and hyperkinesis of the basal segments. Coronary angiography showed patent epicardial coronary arteries; LV angiography demonstrated the characteristic morphology of apical ballooning with hyperkinesis of the basal segments and hypokinesis of the mid-apical segments. The post-procedural course was uneventful; on day 5 after admission the echocardiogram revealed full recovery of apical and mid-ventricular regional wall-motion abnormalities.
Takotsubo cardiomyopathy is a relatively rare, unique entity that has only recently been widely appreciated. Acute stress has been indicated as a common trigger for the transient LV apical ballooning syndrome, especially in postmenopausal women. The present report is a typical example of stress-induced takotsubo cardiomyopathy in a Caucasian Italian postmenopausal woman.
- Takotsubo Cardiomyopathy
- Apical Ballooning
- Minor Elevation
- Apical Ballooning Syndrome
Takotsubo cardiomyopathy, also known as transient left ventricular (LV) apical ballooning syndrome, is an acute cardiac syndrome characterized by transient LV regional wall motion abnormalities, chest pain or dyspnea, ST-segment elevation and minor elevations of cardiac enzyme levels . The typical feature of the syndrome is a transient regional systolic dysfunction involving the LV apex and mid-ventricle with concomitant hyperkinesis of the basal LV segments . The syndrome has been first described in the Japanese population  and subsequently in the Caucasian population in both Europe  and U.S. , and was named takotsubo after a round bottomed narrow-necked Japanese fishing pot used for trapping octopus.
Takotsubo cardiomyopathy is a relatively rare, unique entity that has only recently been widely appreciated . Although the exact cause of the syndrome remains unknown, many underlying mechanisms have been, so far, proposed including diffuse epicardial arteries spasm, coronary microcirculation dysfunction, cathecolamines-induced myocardial dysfunction, and neurologically-mediated myocardial stunning . Acute stress has been indicated as a common trigger for the transient LV apical ballooning syndrome [1, 5]. Interestingly, it has been reported that the majority of patients experiencing the syndrome were post-menopausal Japanese women who present ischemic-like chest pain early after an episode of acute emotional or physiologic stress [1, 5]. In general most patients were women (ranging from 82 to 100% in different series) with a mean age at presentation of approximately 70 years . Explanation for this dramatic sex and age discrepancy can only be speculated, however it may be possibly related to post-menopausal alterations of endothelial function secondary to reduced estrogen levels and microcirculatory vasomotor reactivity to cathecolamine-mediated stimuli . Initially, takotsubo cardiomyopathy was believed to have a peculiar geographic and racial distribution given the predilection for Japanese women and the lack of reports of case-series from other countries [1, 2]. Desmet et al. in 2003 first described the syndrome in a series of 13 Caucasian patients from Belgium ; more recently other groups from both North America and Europe reported series of LV apical ballooning in white women, the largest, by Sharkey et al., involving 22 subjects [1, 4, 6, 7]. The present case is a typical example of stress-induced takotsubo cardiomyopathy in a Caucasian Italian postmenopausal woman.
Written consent was obtained from the patient for publication of the study.
- Bybee KA, Kara T, Prasad A, Lerman A, Barsness GW, Wright S, Rihal CS: Systematic review: transient left ventricular apical ballooning: a syndrome that mimics ST-segment elevation acute myocardial infarction. Ann Intern Med 2004, 141: 858-865.View ArticlePubMedGoogle Scholar
- Dato K, Sato H, Tateishi H, Uchida T, Ishihara M: Myocardial stunning due to simultaneous multivessel coronary spasms: a review of 5 cases. J Cardiol 1991, 21: 203-214.Google Scholar
- Desmet WJ, Adrianssens BF, Dens JA: Apical ballooning of the left ventricle: first series in white patients. Heart 2003, 89: 1027-1031. 10.1136/heart.89.9.1027View ArticlePubMedPubMed CentralGoogle Scholar
- Bybee KA, Prasad A, Barness GW, Lerman A, Jaffe AS, Murphy JG, Wright RS, Rihal CS: Clinical characteristics and thrombolysis in myocardial infarction frame counts in women with transient left ventricular apical ballooning syndrome. Am J Cardiol 2004, 94: 343-346. 10.1016/j.amjcard.2004.04.030View ArticlePubMedGoogle Scholar
- Sato M, Fujita S, Saito S, Ikeda Y, Kitazawa H, Takahashi M, Ishiguro J, Okabe M, Nakamura Y, Nagai T, Watanabe H, Kodama M, Aizawa Y: Increased incidence of transient left ventricular apical ballooning (so-called "Takotsubo" cardiomypathy) after the mid-Niigata Prefecture earthquake. Circ J 2006, 70: 947-953. 10.1253/circj.70.947View ArticlePubMedGoogle Scholar
- Sharkey SW, Lesser JR, Zenovich AG, Maron MS, Lindberg J, Longe TF, Maron BJ: Acute and reversible cardiomyopathy provoked by stress in women from the United States. Circulation 2005, 111: 472-479. 10.1161/01.CIR.0000153801.51470.EBView ArticlePubMedGoogle Scholar
- Gianni M, Dentali F, Grandi AM, Sumner G, Hiralal R, Lonn E: Apical ballooning syndrome or takotsubo cardiomyopathy: a systematic review. Eur Heart J 2006, 27: 1523-1529. 10.1093/eurheartj/ehl032View ArticlePubMedGoogle Scholar
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