Patients usually present with acute chest pain, dyspnea, and/or palpitations similar to acute coronary syndrome (ACS). The frequent presence of ST segment elevation and/or T wave inversion on electrocardiogram (ECG) and an elevated troponin level also mimic ACS.
Potential complications include congestive heart failure and ventricular arrhythmias, so early recognition and treatment are essential.
The name is derived from the appearance of the left ventricle, which is similar to the shape of a Japanese octopus trap, termed "takotsubo" in Japanese.
It is believed to be caused by sympathetic-mediated myocyte injury. Proposed hypotheses include multivessel coronary spasm, acute increased afterload, myocardial stunning, and acute left ventricular outflow tract obstruction. Diseases that cause catecholamine surge, such as pheochromocytoma, thyrotoxicosis, Addisonian crisis, subarachnoid hemorrhage, and chronic obstructive pulmonary disease (COPD) exacerbation, often result in takotsubo cardiomyopathy.
Postmenopausal women account for >90% of cases. The estimated annual incidence is 50 000-100 000 cases in the United States.
Risk factors include hypertension, lack of estrogen, dyslipidemia, smoking, obesity, hyperthyroidism and other thyroid abnormalities, and diabetes mellitus.
I51.81 – Takotsubo syndrome
441541008 – Takotsubo cardiomyopathy
Differential Diagnosis & Pitfalls
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