This Article Extract 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 HighWire Citing Articles via Google Scholar Google Scholar Articles by Girod, J. P. Articles by Brener, S. J. Search for Related Content PubMed PubMed Citation Articles by Girod, J. P. Articles by Brener, S. J. Related Collections Other heart failure Catheter-based coronary and valvular interventions: other

(Circulation. 2003;107:e120.)
© 2003 American Heart Association, Inc.

Images in Cardiovascular Medicine

Tako-Tsubo–Like Transient Left Ventricular Dysfunction

John P. Girod, DO; Adrian W. Messerli, MD; Frank Zidar, MD; W. H. Wilson Tang, MD; Sorin J. Brener, MD

From the Cleveland Clinic Foundation, Cleveland, Ohio.

Correspondence to Sorin J. Brener MD, FACC, Division of Cardiology/F25, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195. E-mail breners{at}ccf.org

A 68-year-old woman presented with mild chest pressure typical of myocardial ischemia. The initial ECG revealed normal sinus rhythm with ST-segment elevations in leads V₂ through V₅ (Figure 1). Troponin T level was 3.4 ng/mL (normal <0.01 ng/mL), and creatinine kinase level was 250 U/L (normal <220 U/L). The patient underwent emergency coronary angiography, which demonstrated minimal atherosclerotic disease. However, contrast left ventriculography demonstrated marked akinesis of the mid and distal segments of all walls, with compensatory hyperkinesis of the base (Figure 2). Transthoracic echocardiography also demonstrated akinesis of the midanterior, apical septal, apical inferior, apical lateral, and apical anterior segments. The right ventricle was normal in size and function. No valvular abnormalities were observed. The patient remained clinically and hemodynamically stable during her 3-day hospitalization. Serial cardiac markers trended down. Viral titers, iron studies, thyroid function tests, and serum protein electrophoresis were noncontributory. Her discharge medications included an aspirin, an ACE inhibitor, a ß-blocker, and a statin. Repeat echocardiography 1 month later demonstrated complete resolution of the regional systolic dysfunction.

View larger version (74K): [in this window] [in a new window]   Figure 1. Twelve-lead ECG. Sinus rhythm with 1- to 2-mm ST elevation in leads V2 through V5.

View larger version (79K): [in this window] [in a new window]   Figure 2. Contrast left ventriculogram. End-diastolic (A) and end-systolic (B) left ventriculograms illustrating apical asynergy.

Tako-tsubo–like (Japanese word for octopus-catcher, Figure 3) left ventricular dysfunction is an enigmatic cardiomyopathy, characterized by marked apical asynergy in the absence of significant coronary disease. Typically, these patients are elderly women who present with mild to moderate chest pain, have ST-segment elevation in leads V₃ through V₆, and have a modest rise in cardiac markers. The exact etiology remains unknown, but the transient dysfunction may be secondary to microvascular spasm or regional myocarditis.

View larger version (116K): [in this window] [in a new window]   Figure 3. An antique tako-tsubo.

Footnotes

The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.

Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke’s Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.

This article has been cited by other articles:

				E. Merli, S. Sutcliffe, M. Gori, and G. G.R. Sutherland Tako-Tsubo cardiomyopathy: New insights into the possible underlying pathophysiology Eur J Echocardiogr, January 1, 2006; 7(1): 53 - 61. [Abstract] [Full Text] [PDF]

This Article Extract 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 HighWire Citing Articles via Google Scholar Google Scholar Articles by Girod, J. P. Articles by Brener, S. J. Search for Related Content PubMed PubMed Citation Articles by Girod, J. P. Articles by Brener, S. J. Related Collections Other heart failure Catheter-based coronary and valvular interventions: other