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Current Cardiology Reviews

Editor-in-Chief

ISSN (Print): 1573-403X
ISSN (Online): 1875-6557

Case Report

Atypical Takotsubo Cardiomyopathy with Hypokinetic Left Mid-ventricle and Apical Wall Sparing: A Case Report and Literature Review

Author(s): Dipesh Ludhwani*, Belaal Sheikh, Vasu K Patel, Khushali Jhaveri, Mohammad Kizilbash and Prashant Sura

Volume 16, Issue 3, 2020

Page: [241 - 246] Pages: 6

DOI: 10.2174/1573403X15666191120114442

Price: $65

Abstract

Background: Takotsubo Cardiomyopathy (TTC) is an uncommon cause of acute reversible ventricular systolic dysfunction in the absence of obstructive Coronary Artery Disease (CAD). Typically manifesting as apical wall ballooning, TTC can rarely present atypically with apical wall sparing.

Case Report: A 62-year-old female presented with complaints of chest pain and features mimicking acute coronary syndrome. Coronary angiogram revealed no obstructive CAD and left ventriculogram showed reduced ejection fraction, normal left ventricular apex and hypokinetic mid-ventricles consistent with atypical TTC. The patient was discharged home on heart failure medications and a follow-up transthoracic echocardiogram demonstrated improved left ventricular function with no wall motion abnormality.

Conclusion: This case report provides an insight into the diagnosis and management of TTC in the absence of pathognomic features.

Keywords: Tako tsubo, takotsubo cardiomyopathy, stress cardiomyopathy, atypical takotsubo, midventricular cardiomyopathy, cardiomyopathy.

Graphical Abstract

[1]
Bybee KA, Kara T, Prasad A, et al. Systematic review: transient left ventricular apical ballooning: A syndrome that mimics ST segment elevation myocardial infarction. Ann Intern Med 2004; 141(11): 858-65.
[http://dx.doi.org/10.7326/0003-4819-141-11-200412070-00010] [PMID: 15583228]
[2]
Tsuchihashi K, Ueshima K, Uchida T, et al. Angina Pectoris-Myocardial Infarction Investigations in Japan. Transient left ventricular apical ballooning without coronary artery stenosis: A novel heart syndrome mimicking acute myocardial infarction. Angina Pectoris-Myocardial Infarction Investigations in Japan. J Am Coll Cardiol 2001; 38(1): 11-8.
[http://dx.doi.org/10.1016/S0735-1097(01)01316-X] [PMID: 11451258]
[3]
Sato H. Taiteishi, et al. Takotsubo-type cardiomyopathy due to multivessel spasm.In: Kodama K, Haze K, Hon M, Eds. Clinical aspect of myocardial injury: From ischemia to heart failure. Kagakuhyouronsha, Tokyo 1990; p. 56.
[4]
Kurowski V, Kaiser A, von Hof K, et al. Apical and midventricular transient left ventricular dysfunction syndrome (tako-tsubo cardiomyopathy): Frequency, mechanisms, and prognosis. Chest 2007; 132(3): 809-16.
[http://dx.doi.org/10.1378/chest.07-0608] [PMID: 17573507]
[5]
Bybee KA, Prasad A, Barsness GW, et al. Clinical characteristics and thrombolysis in myocardial infarction frame counts in women with transient left ventricular apical ballooning syndrome. Am J Cardiol 2004; 94(3): 343-6.
[http://dx.doi.org/10.1016/j.amjcard.2004.04.030] [PMID: 15276100]
[6]
Schneider B, Athanasiadis A, Sechtem U. Gender-related differences in takotsubo cardiomyopathy. Heart Fail Clin 2013; 9(2): 137-46.
[http://dx.doi.org/10.1016/j.hfc.2012.12.005] [PMID: 23562114]
[7]
Deshmukh A, Kumar G, Pant S, Rihal C, Murugiah K, Mehta JL. Prevalence of Takotsubo cardiomyopathy in the United States. Am Heart J 2012; 164(1): 66-71 e1.
[8]
Wittstein IS, Thiemann DR, Lima JA, et al. Neurohumoral features of myocardial stunning due to sudden emotional stress. N Engl J Med 2005; 352(6): 539-48.
[http://dx.doi.org/10.1056/NEJMoa043046] [PMID: 15703419]
[9]
Paur H, Wright PT, Sikkel MB, et al. High levels of circulating epinephrine trigger apical cardiodepression in a β2-adrenergic receptor/Gi-dependent manner: A new model of Takotsubo cardiomyopathy. Circulation 2012; 126(6): 697-706.
[http://dx.doi.org/10.1161/CIRCULATIONAHA.112.111591] [PMID: 22732314]
[10]
Park JH, Kang SJ, Song JK, et al. Left ventricular apical ballooning due to severe physical stress in patients admitted to the medical ICU. Chest 2005; 128(1): 296-302.
[http://dx.doi.org/10.1378/chest.128.1.296] [PMID: 16002949]
[11]
Templin C, Ghadri JR, Diekmann J, et al. Clinical features and outcomes of takotsubo (stress) cardiomyopathy. N Engl J Med 2015; 373(10): 929-38.
[http://dx.doi.org/10.1056/NEJMoa1406761] [PMID: 26332547]
[12]
Scantlebury DC, Prasad A. Diagnosis of takotsubo cardiomyopathy. Circ J 2014; 78(9): 2129-39.
[http://dx.doi.org/10.1253/circj.CJ-14-0859] [PMID: 25131525]
[13]
Ghadri JR, Wittstein IS, Prasad A, et al. International expert consensus document on takotsubo syndrome (Part I): Clinical characteristics, diagnostic criteria, and pathophysiology. Eur Heart J 2018; 39(22): 2032-46.
[http://dx.doi.org/10.1093/eurheartj/ehy076] [PMID: 29850871]
[14]
Nef HM, Möllmann H, Kostin S, et al. Tako-Tsubo cardiomyopathy: Intraindividual structural analysis in the acute phase and after functional recovery. Eur Heart J 2007; 28(20): 2456-64.
[http://dx.doi.org/10.1093/eurheartj/ehl570] [PMID: 17395683]
[15]
Misumi I, Ebihara K, Akahoshi R, et al. Coronary spasm as a cause of takotsubo cardiomyopathy and intraventricular obstruction. J Cardiol Cases 2010; 2(2): e83-7.
[http://dx.doi.org/10.1016/j.jccase.2010.03.007] [PMID: 30524594]
[16]
Patel SM, Lerman A, Lennon RJ, Prasad A. Impaired coronary microvascular reactivity in women with apical ballooning syndrome (Takotsubo/stress cardiomyopathy). Eur Heart J Acute Cardiovasc Care 2013; 2(2): 147-52.
[http://dx.doi.org/10.1177/2048872613475891] [PMID: 24222824]
[17]
Kumar G, Holmes DR Jr, Prasad A. “Familial” apical ballooning syndrome (Takotsubo cardiomyopathy). Int J Cardiol 2010; 144(3): 444-5.
[http://dx.doi.org/10.1016/j.ijcard.2009.03.078] [PMID: 19375184]
[18]
Pelliccia F, Pasceri V, Patti G, et al. Long-term prognosis and outcome predictors in takotsubo syndrome: A systematic review and meta-regression study. JACC Heart Fail 2019; 7(2): 143-54.
[http://dx.doi.org/10.1016/j.jchf.2018.10.009] [PMID: 30611720]
[19]
Looi JL, Lee M, Webster MWI, To ACY, Kerr AJ. Postdischarge outcome after Takotsubo syndrome compared with patients post-ACS and those without prior CVD: ANZACS-QI 19. Open Heart 2018; 5(2) e000918
[http://dx.doi.org/10.1136/openhrt-2018-000918] [PMID: 30564377]
[20]
Jesel L, Berthon C, Messas N, et al. Ventricular arrhythmias and sudden cardiac arrest in Takotsubo cardiomyopathy: Incidence, predictive factors, and clinical implications. Heart Rhythm 2018; 15(8): 1171-8.
[http://dx.doi.org/10.1016/j.hrthm.2018.04.002] [PMID: 29627435]
[21]
Ghadri JR, Cammann VL, Napp LC, et al. International takotsubo (InterTAK) registry. Differences in the clinical profile and outcomes of typical and atypical takotsubo syndrome: Data from the international takotsubo registry. JAMA Cardiol 2016; 1(3): 335-40.
[http://dx.doi.org/10.1001/jamacardio.2016.0225] [PMID: 27438117]
[22]
Milinis K, Fisher M. Takotsubo cardiomyopathy: Pathophysiology and treatment. Postgrad Med J 2012; 88(1043): 530-8.
[http://dx.doi.org/10.1136/postgradmedj-2012-130761] [PMID: 22647668]
[23]
Awad HH, McNeal AR, Goyal H. Reverse Takotsubo cardiomyopathy: A comprehensive review. Ann Transl Med 2018; 6(23): 460.
[http://dx.doi.org/10.21037/atm.2018.11.08] [PMID: 30603648]
[24]
Khoueiry G, Abi Rafeh N, Azab B, et al. Reverse Takotsubo cardiomyopathy in the setting of anaphylaxis treated with high-dose intravenous epinephrine. J Emerg Med 2013; 44(1): 96-9.
[http://dx.doi.org/10.1016/j.jemermed.2011.09.032] [PMID: 22595633]
[25]
Movahed MR, Mostafizi K. Reverse or inverted left ventricular apical ballooning syndrome (reverse Takotsubo cardiomyopathy) in a young woman in the setting of amphetamine use. Echocardiography 2008; 25(4): 429-32.
[http://dx.doi.org/10.1111/j.1540-8175.2007.00604.x] [PMID: 18177388]
[26]
Chehab O, Ioannou A, Sawhney A, Rice A, Dubrey S. Reverse Takotsubo Cardiomyopathy and cardiogenic shock associated with methamphetamine consumption. J Emerg Med 2017; 53(5): e81-3.
[http://dx.doi.org/10.1016/j.jemermed.2017.06.027] [PMID: 28916123]
[27]
Alexakis LC, Arapi S, Stefanou I, Gargalianos P, Astriti M. Transient reverse takotsubo cardiomyopathy following a spider bite in Greece: A case report. Medicine (Baltimore) 2015; 94(5) e457
[http://dx.doi.org/10.1097/MD.0000000000000457] [PMID: 25654384]
[28]
Rodriguez-Castro CE, Saifuddin F, Porres-Aguilar M, et al. Reverse takotsubo cardiomyopathy with use of male enhancers. Proc Bayl Univ Med Cent 2015; 28(1): 78-80.
[http://dx.doi.org/10.1080/08998280.2015.11929197] [PMID: 25552809]
[29]
Kaoukis A, Panagopoulou V, Mojibian HR, Jacoby D. Reverse Takotsubo cardiomyopathy associated with the consumption of an energy drink. Circulation 2012; 125(12): 1584-5.
[http://dx.doi.org/10.1161/CIRCULATIONAHA.111.057505] [PMID: 22451608]
[30]
Penas-Lado M, Barriales-Villa R, Goicolea J. Transient left ventricular apical ballooning and outflow tract obstruction. J Am Coll Cardiol 2003; 42(6): 1143-4.
[http://dx.doi.org/10.1016/S0735-1097(03)00892-1] [PMID: 13678948]
[31]
Heckle MR, McCoy CW, Akinseye OA, Khouzam RN. Stress-induced thrombus: Prevalence of thromboembolic events and the role of anticoagulation in Takotsubo cardiomyopathy. Ann Transl Med 2018; 6(1): 4.
[http://dx.doi.org/10.21037/atm.2017.11.01] [PMID: 29404350]
[32]
Santoro F, Stiermaier T, Tarantino N, et al. Left Ventricular thrombi in takotsubo syndrome: incidence, predictors, and management: Results from the GEIST (German Italian Stress Cardiomyopathy) registry. J Am Heart Assoc 2017; 6(12) e006990
[http://dx.doi.org/10.1161/JAHA.117.006990] [PMID: 29203578]
[33]
Ludhwani D, Rahaby M, Patel V, Jamil S, Kedzia A, Wu C. Implications of left bundle branch block in takotsubo cardiomyopathy: Propensity match analysis from the national inpatient sample. Cardiol Ther 2019; 8(2): 253-65.
[http://dx.doi.org/10.1007/s40119-019-0141-6] [PMID: 31317468]
[34]
Buccheri D, Zambelli G. The link between spontaneous coronary artery dissection and takotsubo cardiomyopathy: Analysis of the published cases. J Thorac Dis 2017; 9(12): 5489-92.
[http://dx.doi.org/10.21037/jtd.2017.11.07] [PMID: 29312758]
[35]
Duran JM, Naderi S, Vidula M, et al. Spontaneous coronary artery dissection and its association with takotsubo syndrome: Novel insights from a tertiary center registry. Catheter Cardiovasc Interv 2019.
[http://dx.doi.org/10.1002/ccd.28314] [PMID: 31037831]
[36]
Y-Hassan. Spontaneous coronary artery dissection and takotsubo syndrome: An often overlooked association.[review] Cardiovasc Revasc Med 2018; 19(6): 717-23.
[PMID: 29502960]
[37]
Franco C, Starovoytov A, Heydari M, Mancini GB, Aymong E, Saw J. Changes in left ventricular function after spontaneous coronary artery dissection. Clin Cardiol 2017; 40(3): 149-54.
[http://dx.doi.org/10.1002/clc.22640] [PMID: 28218398]

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