Takotsubo cardiomyopathy (TTC), also known as “broken heart syndrome” or stress-induced cardiomyopathy was described for the first time by Sato et al. from Japan in 1990. The typical Takotsubo presentation with apical dysfunction and a hypercontractile base of the left ventricle led Sato and colleagues to compare the end-systolic appearance during ventriculography to the local Japanese fisherman´s octopus pot.
Typically, physicians encounter TTC in elderly (>60 years) postmenopausal women after a relevant emotional and/or physical stress event. TTC has a strong female predominance. In addition TTC mimics acute coronary syndrome (ACS) with symptoms such as angina and dyspnea, ECG changes like ST-segment elevation/depression, and also T-wave inversion as well as modest elevation of cardiac biomarkers.
TTC is characterized by a transient, reversible, regional systolic dysfunction involving the left ventricular apex and mid-ventricle with hyperkinesis of the basal left ventricular segments, usually in the absence of obstructive epicardial coronary artery disease. During the last decades, TTC has gained increasing recognition among physicians as well as researchers and reports have shown that besides the typical apical ballooning diverse atypical ballooning patterns including the midventricular, basal and focal type.
The pathophysiology of this clinical entity remains mysterious. It has been suggested that coronary vascular dysfunction, abnormal coronary microcirculation, excessive sympathetic stimulation (intracranial bleeding, pheochromocytoma as catecholamine-mediated cardiac toxicity), neurogenic stunning and left ventricular outflow obstruction might be involved in the pathogenesis. However the exact mechanism leading to TTC is still unknown.
The diagnosis of TTC, a rare but not unique condition among patients with ACS, is currently based on coronary angiography and echocardiography. TTC has a generally favorable prognosis as the wall motion abnormality usually resolves completely within days to weeks after symptom onset. However, during the acute phase TTC can be a life-threatening condition and TTC-patients should be monitored as closely as ACS-patients to avoid severe in-hospital complications.