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Ann Thorac Surg 2009;87:962. doi:10.1016/j.athoracsur.2008.11.075
© 2009 The Society of Thoracic Surgeons
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Images in Cardiothoracic Surgery

Takotsubo Cardiomyopathy

Georgios P. Georghiou, MDa,*, Savvas S. Constantinides, MD, MRCPa, Marinos C. Soteriou, MDb, Marnelos G. Panagiotis, MDb, Christos P. Christou, MDb,b

a Department of Cardiothoracic Surgery, American Heart Institute, Nicosia, Cyprus
b Department of Cardiology, American Heart Institute, Nicosia, Cyprus

* Address correspondence to Dr Georghiou, Department of Cardiothoracic Surgery, American Heart Institute, PO Box 25610, Nicosia, 1311, Cyprus (Email: georgios_georghiou{at}cytanet.com.cy).

A 62-year old woman presented to our institute with dyspnea and hypotension. The electrocardiogram showed extensive ST elevation in V1-V6, with a negative T wave in leads II, III, and aVF. The troponin T concentration was 0.83 ng/mL (upper normal limit, 0.1 ng/mL). An echocardiography showed a significantly depressed left ventricular (LV) function with extensive akinesis and dyskinesis of all apical and midventricular segments, sparing the basal segments, which were contracting vigorously. The patient had an estimated LV ejection fraction of 0.35. On the basis of the typical shape of the dysfunctioning LV, the fact that the extensive wall motion abnormalities did not follow a coronary distribution pattern, and the coronary arteries were normal on angiography despite the presence of LV angiography of typical apical ballooning (Fig 1) with compensatory basal hyperkinesis, Takotsubo syndrome was diagnosed (arrows).


Figure 1
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  		Fig 1.
 
After 2 days of supportive measures, the patient's status improved clinically, the ST elevation turned to a normal pattern, and the echocardiography showed normalization of myocardium function. The patient was discharged 2 days later.

The syndrome is also known as "acute left ventricular ballooning," "transient apical ballooning," "ampulla cardiomyopathy," "broken-heart syndrome," or "human stress cardiomyopathy," because stress has been implicated in its pathophysiology. Enhanced awareness may lead to increasing recognition of this new nosological entity as a possible complication of cardiac operations.





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