Tako Tsubo syndrome: A literature review and a case report


The Tako-Tsubo syndrome is a rare yet recognized condition characterized by acute but rapidly reversible left ventricular dysfunction in absence of obstructive coronary artery stenosis. Although several factors have been associated with the development of this syndrome, still its etiology remains undefined. We report the case of a 51-years-old woman presenting with dyspnea in whom the diagnosis of Tako-Tsubo syndrome was posed. We describe the diagnostic modalities and the clinical outcome of the patient. Secondly, the present paper is aimed at providing a review of the current evidence over this topic and at proposing future research directions.

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Bartolomucci, F. , Nasso, G. , Cipriani, F. , Deluca, G. , Sgarra, G. , D’Agostino, C. and Speziale, G. (2012) Tako Tsubo syndrome: A literature review and a case report. World Journal of Cardiovascular Diseases, 2, 118-123. doi: 10.4236/wjcd.2012.23019.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Satoh, H.T.H., Tateishi, H., Uchida, T., et al. (1990) Takotsubotype cardiomyopathy due to multivessel spasm. In: Kodama, K., Haze, K. and Hon, M., Eds., Clinical Aspect of Myocardial Injury: From Ischemia to Heart Failure (in Japanese). Kagakuhyouronsya Co., Tokyo, 56-64.
[2] Desmet, W., Adriaenssens, B. and Dens, J.A. (2003) Apical ballooning of the left ventricle: First series in white patients. Heart, 89, 1027-1031. doi:10.1136/heart.89.9.1027
[3] Kumar, G., Holmes, D. Jr. and Prasad, A. (2010) Familial apical ballooning syndrome (Takotsubo-cardiomyopathy). International Journal of Cardiology, 144, 444-445. doi:10.1016/j.ijcard.2009.03.078
[4] Bybee, K.A., Murphy, J., Prasad, A., Wright, R.S., Lerman, A., Rihal, C.S., et al. (2006) Acute impairment of regional myocardial glucose uptake in the apical ballooning (takotsubo) syndrome. Journal of Nuclear Cardiology, 13, 244-250.
[5] Maruyama, S., Nomura, Y., Fukushige, T., Eguchi, T., Nishi, J., Yoshinaga, M., et al. (2006) Suspected tako- tsubo cardiomyopathy caused by withdrawal of bupirenorphine in a child. Circulation Journal, 70, 509-511. doi:10.1253/circj.70.509
[6] Gianni, M., Dentali, F., Grandi, A.M., Sumner, G., Hiralal, R. and Lonn, E. (2006) Apical ballooning syndrome or takotsubo cardiomyopathy: A systematic review. European Heart Journal, 27, 1523-1529. doi:10.1093/eurheartj/ehl032
[7] Reuss, C.S., Lester, S.J., Hurst, R.T., Askew, J.W., Nager, P., Lusk, J., et al. (2007) Isolated left ventricular basal ballooning phenotype of transient cardiomyopathy in young women. American Journal of Cardiology, 99, 1451- 1453. doi:10.1016/j.amjcard.2006.12.078
[8] Sharkey, S.W., Lesser, J.R., Zenovich, A.G., et al. (2005) Acute and reversible cardiomyopathy provoked by stress in women from the United States. Circulation, 111, 472- 479. doi:10.1161/01.CIR.0000153801.51470.EB
[9] Kurisu, S., Inoue, I., Kawagoe, T., Ishihara, M., Shimatani, Y., Nakamura, S., et al. (2004) Time course of electrocardiographic changes in patients with tako-tsubo syndrome: Comparison with acute myocardial infarction with minimal enzymatic release. Circulation Journal, 68, 77-81. doi:10.1253/circj.68.77
[10] Pilgrim, T.M. and Wyss, T.R. (2008) Takotsubo-cardio- myopathy or transient left ventricular apical ballooning syndrome: A systematic review. International Journal of Cardiology, 124, 283-292. doi:10.1016/j.ijcard.2007.07.002
[11] Sztajzel, J. and Urban, P. (2000) Early and late Q wave regression in the setting of acute myocardial infarction. Heart, 83, 708-710. doi:10.1136/heart.83.6.708
[12] Kurisu, S., Inoue, I., Kawagoe, T., Ishihara, M., et al. (2011) Incidence and treatment of left ventricular apical thrombosis in Tako Tsubo cardiomiopathy. International Journal of Cardiology, 146, e58-e60. doi:10.1016/j.ijcard.2008.12.208
[13] Wittstein, I.S., Thiemann, D.R., Lima, J.A., Baughman, K.L., Schulman, S.P., Gerstenblith, G., et al. (2005) Neurohumoral features of myocardial stunning due to sudden emotional stress. The New England Journal of Medicine, 352, 539-548. doi:10.1056/NEJMoa043046
[14] Dote, K., Sato, H., Tateishi, H., Uchida, T. and Ishihara, M. (1991) Myocardial stunning due to simultaneous multivessel spasms: A review of five cases. Journal of Cardiology, 21, 203-214.
[15] Kurisu, S., Sato, H., Kawagoe, T., Ishihara, M., Shimatani, Y., Nishioka, K., et al. (2002) Tako-tsubo-like left ventricular dysfunction with ST-segment elevation: A novel cardiac syndrome mimicking acute myocardial infarction. American Heart Journal, 143, 448-455. doi:10.1067/mhj.2002.120403
[16] Abe, Y., Kondo, M., Matsuoka, R., Araki, M., Dohyama, K. and Tanio, H. (2003) Assessment of clinical features in transient left ventricular apical ballooning. Journal of the American College of Cardiology, 41, 737-742. doi:10.1016/S0735-1097(02)02925-X
[17] Ito, K., Sugihara, H., Katoh, S., Azuma, A. and Nakagawa, M. (2003) Assessment of Takotsubo (ampulla) cardiomyopathy using 99m Tc-Tetrofosmin myocardial SPECT-comparision with acute coronary syndrome. Annals of Nuclear Medicine, 17, 115-122. doi:10.1007/BF02988449
[18] Scanzerla, P., Alioto, G., Funaro, A., Passaretti, B., Borghini, E. and Guglielmetto, S. (2008) Transthoracic Doppler ultrasound flow reserve evaluation: Preliminary insights into pathophysiology of Takotsubo cardiomyopathy. Journal of Cardiovascular Medicine, 12, 1229-1234. doi:10.2459/JCM.0b013e328313e890
[19] Lyon, A., Rees, P.S.C., Prasad, S., Poole-Wilson, P.A. and Harding, S.E. (2008) Stress (Takotsubo) cardiomyopathy—A novel pathophysiological hypothesis to explain catecholamine-induced acute myocardial stunning. Nature Clinical Practice, 5, 22-29. doi:10.1038/ncpcardio1066
[20] Ueyama, T., Kasamatsu, K., Hano, T., Yamamoto, K., Tsuruo, Y. and Nishio, I. (2002) Emotional stress induces transient left ventricular hypocontraction in the rat via activation of cardiac adrenoceptors: A possible animal model of ‘tako-tsubo’ cardiomyopathy. Circulation Journal, 66, 712-713. doi:10.1253/circj.66.712
[21] Akashi, Y.J., Nakazawa, K., Sakakibara, M., Miyake, F., Musha, H. and Sasaka, K. (2004) 123I-MIBG myocardial scintigraphy in patients with ‘takotsubo’ cardiomyopathy. Journal of Nuclear Medicine, 45, 1121-1127.
[22] Avegliano, G., Huguet, M., Costabel, P.J., Ronderos, R., Bijnens, B., Kuschnir, P., et al. (2011) Morphologic pattern of late Gadolinium Enhancement in Tako Tsubo Cardiomyopathy detected by early Cardiovascular Magnetic Resonance. Clinical Cardiology, 34, 178-182. doi:10.1002/clc.20877
[23] Mitchell, J.H., Hadden, T.B., Wilson, J.M., Achari, A., Muthupillai, R. and Flamm, S.D. (2007) Clinical features and usefulness of cardiac magnetic resonance imaging in assessing myocardial viability and prognosis in Tako- tsubo cardiomyopathy (transient left ventricular apical ballooning syndrome). American Journal of Cardiology, 100, 296-301. doi:10.1016/j.amjcard.2007.02.091
[24] Nanda, S., Bhatt, S.P., Dale, T.H., Kurowki, V., Burgdorf, C. and Radke, P.W. (2008) Tako tsubo cardiomyopathy: An insight into pathogenesis. Chest, 133, 583-584. doi:10.1378/chest.07-1745
[25] Sharkey, S.W., Lesser, J.R., Zenovich, A.G., Maron, M.S., Lindberg, J., Longe, T.F. and Maron, B.J. (2005) Acute and reversible cardiomyopathy provoked by stress in women from the United States. Circulation, 111, 472-479. doi:10.1161/01.CIR.0000153801.51470.EB
[26] Rolf, A., Nef, M.H., M?llmann, H., Troidl, C., Voss, S., Conradi, G., et al. (2009) Immunohistological basis of the late gadolinium enhancement phenomenon in Tako Tsubo cardiomyopathy. European Heart Journal, 30, 1635-1642. doi:10.1093/eurheartj/ehp140
[27] Shrikanth, P.Y., et al. (2005) Tako Tsubo cardiomyopathy (transient left ventricular apical ballooning): Case report of a myocardial perfusion echocardiogram study. Journal of the American Society of Echocardiography, 18, e10- e14.
[28] Wei, K. and Kaul, S. (2004) The coronary microcirculation in health and disease. Cardiology Clinics, 22, 221- 231. doi:10.1016/j.ccl.2004.02.005
[29] Nef, H.M., M?llmann, H., Troidl, C., Kostin, S., et al. (2009) Abnormalities in intracellular Ca2+ regulation contribute to the pathomechanism of Tako-Tsubo cardio- myopathy. European Heart Journal, 30, 2155-2164. doi:10.1093/eurheartj/ehp240
[30] Galiuto, L., Ranieri De Caterina, A., Porfidia, A., Para- ggio, L., et al. (2010) Reversible coronary microvascular dysfunction: A common pathogenetic mechanism in apical ballooning or Tako-Tsubo syndrome. European Heart Journal, 31, 1319-1327. doi:10.1093/eurheartj/ehq039
[31] Bielecka-Dabrowa, A., Mikhailidis, D.P., Hannam, S., et al. (2010) Takotsubo-cardiomyopathy—The current state of knowledge. International Journal of Cardiology, 142, 120-125. doi:10.1016/j.ijcard.2009.11.040
[32] Rigo, F., Sicari, R., Citro, R., et al. (2009) Diffuse, marked, reversible impairment in coronary microcirculation in stress cardiomyopathy: A doppler transthoracic echo study. Annals of Medicine, 41, 462-470. doi:10.1080/07853890903022793
[33] Hurst, R.T., Prasad, A., Askew, J.W., et al. (2010) Takotsubo Cardiomyopathy: A unique cardiomyopathy with variable ventricular morphology. JACC: Cardiovascular Imaging, 3, 641-649. doi:10.1016/j.jcmg.2010.01.009
[34] Akashi, Y.J., Nakazawa, K., Sakakibara, M., et al. (2003) The clinical features of takotsubo cardiomyopathy. QJM: An International Journal of Medicine, 96, 563-573. doi:10.1093/qjmed/hcg096
[35] Bybee, K.A., Kara, T., Prasad, A., et al. (2004) Systematic review: Transient left ventricular apical ballooning: A syndrome that mimics ST-segment elevation myocardial infarction. Annals of Internal Medicine, 141, 858-865.
[36] Prasad, A., Lerman, A. and Rihal, C.S. (2008) Apical ballooning syndrome (Tako-Tsubo or stress cardiomyo-pathy): A mimic of acute myocardial infarction. American Heart Journal, 155, 408-417. doi:10.1016/j.ahj.2007.11.008
[37] Shimizu, M., Kato, Y., Masai, H., Shima, T., et al. (2006) Recurrent episodes of takotsubo-like transient left ventricular ballooning occurring in different regions: A case report. Journal of Cardiology, 48, 101-107.

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