Takotsubo (stress induced) cardiomyopathy
Takotsubo (stress induced) cardiomyopathy
MC in postmenopausal women or hx of mental health problem
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PATHO
PATHO
Acute stressor ➔ reversible ballooning of left ventricle
Activation of sympathetic nervous system or admin of catecholamines/dobuatmine ➔ ↑↑↑ DA, EPI, NE ➔ acute cardiotoxicity or vascular spasm ➔ mid-cavity/apex (MC) ballooning
Takotsubo is Japanese for octopus trap (Tako - octopus, Tsubo = pot)
SSX
SSX
LOOKS LIKE MI - Chest pain
HF pulmonary edema ➔ diff breathing
Syncope, arrhythmia
DX
DX
Get an EKG (first test) and cardiac labs (troponin) because it presents like any other CP
ST Elevation usually in V1-V6 and usually without reciprocal ∆'s/depression
Coronary angiography because it presents like any other CP and angiography (with PCI) is gold standard in ACS
Findings NOT seen in acute MI: normal coronary arteries (no plaque) or non-obstructive coronary disease
ECHO (after ACS is r/o) shows apical ballooning/dyskinesia
How they could trick you 🤷♂️:
They paint the perfect picture (50yo woman presents with SSX after stressful event) and you don't pick EKG as first test
After EKG they do angiography that is normal and you don't pick Takotsubo
TX
TX
Acute tx: ASA, nitro, β-blockers, heparin, angiography because it presents like any other CP
TX HF sx (ACEi, β-blocker) and follow with serial ECHOs to make sure it is resolving
If they are unstable and you hear anything about a left ventricular outflow tract obstruction: Use vasopressor - don't use inotropes
Inotropes make LVOT obstruction worse
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