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(Circulation. 2006;113:e762.)
© 2006 American Heart Association, Inc.

Images in Cardiovascular Medicine

Takotsubo Cardiomyopathy

Dipak P. Shah, MD; Lissa Sugeng, MD; Sascha N. Goonewardena, MD; Patrick Coon, BS, RDCS; Roberto M. Lang, MD

From the Section of Cardiology, Department of Medicine, University of Chicago, Chicago, Ill.

Correspondence to Roberto M. Lang, MD, FACC, University of Chicago Medical Center, Section of Cardiology, MC 5084, 5841 S Maryland Ave, Chicago, IL 60637. E-mail rlang{at}medicine.bsd.uchicago.edu

A 63-year-old woman with hypertension presented with chest pain after an argument with her spouse. On arrival, her ECG disclosed ST-segment elevations in the precordial leads with elevated cardiac enzymes. The patient had a prompt transthoracic echocardiogram (TTE), which demonstrated systolic dysfunction with apical ballooning (arrows in Figure, A). Subsequent contrast enhancement of her TTE displayed a paucity of contrast in the apex, thereby signifying perfusion defects in that region (arrows in Figure, D). The patient then underwent emergent cardiac catheterization, which failed to demonstrate coronary artery disease (left coronary artery shown in Figure, F) but did confirm moderate systolic dysfunction with apical ballooning (Figure, C). The patient was medically managed and discharged in stable condition, with follow-up at 3 weeks demonstrating nearly total recovery of cardiac function; the estimated ejection fraction quantified this recovery by increasing from 42% to 56% (Figure, B). Her repeated contrast TTE showed enhancement of the apex consistent with improved perfusion (arrows in Figure, E). Her clinical presentation is consistent with that of Takotsubo cardiomyopathy (Japanese for octopus catcher), a syndrome associated with elderly women often in emotional distress that is characterized by transient apical regional wall motion abnormalities in the absence of epicardial coronary artery disease. Perfusion deficits seen on these contrast TTE images support the hypothesis that Takotsubo cardiomyopathy may be intimately associated with microvascular dysfunction.

View larger version (120K): [in this window] [in a new window]   A, TTE demonstrating apical ballooning. B, Follow-up TTE portraying recovery of apical function. C, Left ventriculogram confirming moderate systolic dysfunction and apical ballooning. D, Myocardial contrast echocardiogram demonstrating perfusion defects in the apical region. E, Follow-up myocardial contrast echocardiogram delineating recovery and perfusion of the apical region. F, Cardiac catheterization demonstrating no epicardial coronary artery disease of the left coronary artery.

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Issue Highlights
Circulation 2006 113: 2261. [Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Shah, D. P. Articles by Lang, R. M. Search for Related Content PubMed PubMed Citation Articles by Shah, D. P. Articles by Lang, R. M. Pubmed/NCBI databases Medline Plus Health Information Cardiomyopathy Related Collections Other heart failure Echocardiography Related Article