d o
t o r e g . c o m
Dr. Mete ALPASLAN
Takotsubo (Tako-Tsubo) Cardiomyopathy and the ECG
Takotsubo cardiomyopathy
=
stress cardiomyopathy
=
apical ballooning syndrome.
Etiology
Takotsubo cardiomyopathy is a stress induced disorder.
Either emotional or physical stress may induce Takotsubo cardiomyopathy.
Diagnostic criteria
Chest pain and dyspnea may suggest acute myocardial infarction.
Echocardiography or ventriculography reveals systolic dysfunction, usually
apical ballooning
.
Coronary angiography reveals normal coronary arteries.
Cardiac enzymes may be normal or slightly elevated.
About Takotsubo cardiomyopathy
Most of the subjects are postmenopausal women.
Patients usually complain of chest pain and dyspnea. Clinical features may resemble acute coronary syndrome.
There is transient apical ballooning of the left ventricle. Right ventricle is rarely involved.
Pathophysiology has not been elucidated yet.
Long term prognosis is generally good. Systolic dysfunction usually disappears in several weeks.
The ECG findings in Takotsubo cardiomyopathy resembles those of acute cerebral bleeding.
ECG abnormalities that are reported in patients with Takotsubo cardiomyopathy
ST segment elevation
.
Deeply negative T and U waves
in chest leads.
QT interval prolongation
.
Arrhythmias
including frequent VPCs and rarely Torsades de pointes (TdP).
References
J Korean Med Sci 2011;26:959-961.
JACC Cardiovasc Imaging 2010;3:641-649.
Ther Adv Cardiovasc Dis 2010;4:105-107.
Int J Cardiol 2010;142:120-125.
Clin Cardiol 2009;32:614-620.
Am Heart J 2008;155:408-417.
ECG 1a. This ECG belongs to a woman who experienced syncope after intense emotional stress. On admission to the
emergency room, she complained of dyspnea. Her initial ECG shows first degree av block with negative U waves in chest
leads . Her heart rate is below 50/minute. She was later diagnosed as Takotsubo Cardiomyopathy.
Dr. Sang-Ho Park has donated the above ECG to our website.
Click here for a more detailed ECG
ECG 1b. The same patient's second ECG in the emergency room shows deeply negative T and U waves in chest leads.
The QT interval is also prolonged.
Dr. Sang-Ho Park has donated the above ECG to our website.
Click here for a more detailed ECG
ECG 1c. Her third ECG in the emergency room shows QT interval prolongation and frequent VPCs and ventricular couplet .
Dr. Sang-Ho Park has donated the above ECG to our website.
Click here for a more detailed ECG
ECG 1d. The same patient's ECG in the coronary care unit is shown above. QT interval is prolonged and frequent VPCs persist.
The T waves and U waves in the chest leads are deeply negative.
Dr. Sang-Ho Park has donated the above ECG to our website.
Click here for a more detailed ECG
ECG 1e. Another ECG of the same patient which was recorded in the coronary care unit.
Dr. Sang-Ho Park has donated the above ECG to our website.
Click here for a more detailed ECG
ECG 1f. This ECG was also recorded in the coronary care unit and shows that the amplitude of the negative T and U waves in
leads C2 and C3 have started to decrease.
Dr. Sang-Ho Park has donated the above ECG to our website.
Click here for a more detailed ECG
ECG 1g. Her latest ECG in the coronary care unit shows ST segment elevation . The amplitude of the negative T and U waves
have decreased.
Dr. Sang-Ho Park has donated the above ECG to our website.
Click here for a more detailed ECG
ECG 2. The above ECG belongs to a 44 years-old dyslipidemic woman complaining of chest pain.
She was later diagnosed as Takotsubo cardiomyopathy.
Dr. Nils Johnson has donated the above ECG to our website..
Click here for a more detailed ECG
Figure 2a. The same patient's left coronary arteriogram did not show any
significant obstruction.
Dr. Nils Johnson has donated the above angiogram to our website.
Figure 2b. The same patient's right coronary arteriogram did not show any
obstruction.
Dr. Nils Johnson has donated the above angiogram to our website.
Figure 2c. The same patient's left ventriculogram: end-diastole.
Dr. Nils Johnson has donated the above angiogram to our website.
Figure 2d. The same patient's left ventriculogram: end-systole. Apical ballooning
is observed: The left ventricular apex does not become occluded . However,
basal portion of left ventricle can move to the inner left ventricle . This
appearance gives its name to the Tako-tsubo's cardiomyopathy. This end-systolic
appearance resembles the fishing pot which is used by Japanese fisherman for
trapping octopus.
Dr. Nils Johnson has donated the above angiogram to our website.
ECG 3. The ECG above is from a 82 years-old woman with the complaints of chest pain and dyspnea.
ST segment elevation in the inferior leads (II, III and aVF) and V3, and V4 are seen.
Emergent coronary angiography showed normal coronary arteries.
This patient was diagnosed as BIventricular Takotsubo cardiomyopathy.
The ECG above has been used with the permission of Texas Heart Institute Journal.
Click here for a more detailed ECG
Click here to go to the relevant article of the Texas Heart Institute Journal
Takotsubo cardiomyopathy
=
stress cardiomyopathy
=
apical ballooning syndrome.
Etiology
Takotsubo cardiomyopathy is a stress induced disorder.
Either emotional or physical stress may induce Takotsubo cardiomyopathy.
Diagnostic criteria
Chest pain and dyspnea may suggest acute myocardial infarction.
Echocardiography or ventriculography reveals systolic dysfunction, usually
apical ballooning
.
Coronary angiography reveals normal coronary arteries.
Cardiac enzymes may be normal or slightly elevated.
About Takotsubo cardiomyopathy
Most of the subjects are postmenopausal women.
Patients usually complain of chest pain and dyspnea. Clinical features may resemble acute coronary syndrome.
There is transient apical ballooning of the left ventricle. Right ventricle is rarely involved.
Pathophysiology has not been elucidated yet.
Long term prognosis is generally good. Systolic dysfunction usually disappears in several weeks.
The ECG findings in Takotsubo cardiomyopathy resembles those of acute cerebral bleeding.
ECG abnormalities that are reported in patients with Takotsubo cardiomyopathy
ST segment elevation
.
Deeply negative T and U waves
in chest leads.
QT interval prolongation
.
Arrhythmias
including frequent VPCs and rarely Torsades de pointes (TdP).
References
J Korean Med Sci 2011;26:959-961.
JACC Cardiovasc Imaging 2010;3:641-649.
Ther Adv Cardiovasc Dis 2010;4:105-107.
Int J Cardiol 2010;142:120-125.
Clin Cardiol 2009;32:614-620.
Am Heart J 2008;155:408-417.
ECG 1a. This ECG belongs to a woman who experienced syncope after intense emotional stress. On admission to the
emergency room, she complained of dyspnea. Her initial ECG shows first degree av block with negative U waves in chest
leads . Her heart rate is below 50/minute. She was later diagnosed as Takotsubo Cardiomyopathy.
Dr. Sang-Ho Park has donated the above ECG to our website.
Click here for a more detailed ECG
ECG 1b. The same patient's second ECG in the emergency room shows deeply negative T and U waves in chest leads.
The QT interval is also prolonged.
Dr. Sang-Ho Park has donated the above ECG to our website.
Click here for a more detailed ECG
ECG 1c. Her third ECG in the emergency room shows QT interval prolongation and frequent VPCs and ventricular couplet .
Dr. Sang-Ho Park has donated the above ECG to our website.
Click here for a more detailed ECG
ECG 1d. The same patient's ECG in the coronary care unit is shown above. QT interval is prolonged and frequent VPCs persist.
The T waves and U waves in the chest leads are deeply negative.
Dr. Sang-Ho Park has donated the above ECG to our website.
Click here for a more detailed ECG
ECG 1e. Another ECG of the same patient which was recorded in the coronary care unit.
Dr. Sang-Ho Park has donated the above ECG to our website.
Click here for a more detailed ECG
ECG 1f. This ECG was also recorded in the coronary care unit and shows that the amplitude of the negative T and U waves in
leads C2 and C3 have started to decrease.
Dr. Sang-Ho Park has donated the above ECG to our website.
Click here for a more detailed ECG
ECG 1g. Her latest ECG in the coronary care unit shows ST segment elevation . The amplitude of the negative T and U waves
have decreased.
Dr. Sang-Ho Park has donated the above ECG to our website.
Click here for a more detailed ECG
ECG 2. The above ECG belongs to a 44 years-old dyslipidemic woman complaining of chest pain.
She was later diagnosed as Takotsubo cardiomyopathy.
Dr. Nils Johnson has donated the above ECG to our website..
Click here for a more detailed ECG
Figure 2a. The same patient's left coronary arteriogram did not show any
significant obstruction.
Dr. Nils Johnson has donated the above angiogram to our website.
Figure 2b. The same patient's right coronary arteriogram did not show any
obstruction.
Dr. Nils Johnson has donated the above angiogram to our website.
Figure 2c. The same patient's left ventriculogram: end-diastole.
Dr. Nils Johnson has donated the above angiogram to our website.
Figure 2d. The same patient's left ventriculogram: end-systole. Apical ballooning
is observed: The left ventricular apex does not become occluded . However,
basal portion of left ventricle can move to the inner left ventricle . This
appearance gives its name to the Tako-tsubo's cardiomyopathy. This end-systolic
appearance resembles the fishing pot which is used by Japanese fisherman for
trapping octopus.
Dr. Nils Johnson has donated the above angiogram to our website.
ECG 3. The ECG above is from a 82 years-old woman with the complaints of chest pain and dyspnea.
ST segment elevation in the inferior leads (II, III and aVF) and V3, and V4 are seen.
Emergent coronary angiography showed normal coronary arteries.
This patient was diagnosed as BIventricular Takotsubo cardiomyopathy.
The ECG above has been used with the permission of Texas Heart Institute Journal.
Click here for a more detailed ECG
Click here to go to the relevant article of the Texas Heart Institute Journal