Takotsubo cardiomyopathy

Definition:
Takotsubo cardiomyopathy, also known as transient apical ballooning and stress-induced cardiomyopathy, is a type of non-ischemiccardiomyopathy in which there is a sudden temporary weakening of the myocardium (the muscle of the heart). Because this weakening can be triggered by emotional stress, such as the death of a loved one, the condition is also known as broken heart syndrome

Etiology:
its still unknown. initially i was taught to be due to Coronary vasospasm induced by stress but angiography during attack is normal. however there is a strong corilation with stress and studies shows it has a connection with catecholamine release.

Clinical Features:
- Cardiac enzymes did not significantly increase
- serum norepinephrine increased remarkably (1.19ng/ml)
- Coronary angiography revealed normal coronary arteries
- left ventriculography showed akinesis in the apical segments, together with hyperkinesis in the basal segments (a takotsubo shape).normalized within 17.4 hospital days without any treatment.
- Endocardial biopsies did not suggest any specific pathology.
- The cardiac events did not recur over a 1–4 year follow-up.

Diagnosis:
upon presentation it cannot be differentiated with an acute MI. clinical features are the same. on ECG findings it is often mistaken for acute anterior wall MI. but diagnosis is made by the pathognomic wall motion abnormalities, in which the base of the left ventricle is contracting normally or are hyperkinetic while the remainder of the left ventricle is akinetic or dyskinetic

Treatment:
supportive in nature.
In hypotension, support with inotropic agents or an intra-aortic balloon pump.
left ventricular function normalizes generally within 2 months