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Takotsubo Cardiomyopathy (broken heart syndrome) Domina Petric, MD

Takotsubo Cardiomyopathy (broken heart syndrome) Domina Petric, MD. T ransient cardiac syndrome that involves left ventricular apical ak i nesis . M i m ics acute coronary syndrome. ?. chest pain ST-segment elevation elevated cardiac enzyme levels

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Takotsubo Cardiomyopathy (broken heart syndrome) Domina Petric, MD

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  1. Takotsubo Cardiomyopathy(broken heart syndrome)Domina Petric, MD

  2. Transientcardiac syndrome that involves left ventricular apical akinesis.Mimicsacute coronary syndrome. ?

  3. chest pain • ST-segment elevation • elevated cardiac enzyme levels There is no significant coronary artery stenosis, but there is ventricular apical ballooning.

  4. ModifiedMayo Cliniccriteriafordiagnosis are • Transient hypokinesis, dyskinesisor akinesis of the left ventricular middle segments, with or without apical involvement. • Absence of obstructive coronary disease, absence of angiographic evidence of acute plaque rupture. • New ECG abnormalities: ST-segment elevation or/and T-wave inversion. • Moderateelevation in the cardiac troponin level. • Absence of pheochromocytoma or myocarditis.

  5. Patients with Takotsubo cardiomyopathyare found to shift toward the glucose pathway despite relatively normal myocardial perfusion and lack of ischemia in LV segments.

  6. Pathophysiology

  7. Etiology Endogenous catecholamine-induced myocardial stunning and microinfarction! Impaired myocardial fatty acid metabolism! Multivessel coronary artery spasm! Acute coronary syndrome with reperfusion injury! Impaired cardiac microvascular function!

  8. Learning of a death of a loved one! Natural disasters! Bad financial news! Legal problems! Motor vehicle collisions! Surgery! Exacerbation of a chronic medical illness! Intensive care unit stay! Use of or withdrawal from illicit drugs! Risk factors Newly diagnosed, significant medical condition!

  9. Epidemiology • Nearly 90% of reported cases involve postmenopausal women. • Meanpatient age is67 years. • 57.2% Asian, 40% Caucasian 2.8% other races

  10. Nearly 95% of patients experiencing complete recovery within 4-8 weeks.Complications occure in 20% of patients. Prognosis

  11. Death! LV free-wall rupture! Complications

  12. chest pain and dyspnea palpitations nausea vomiting syncope cardiogenic shock Symptoms

  13. Symptoms

  14. Physical exam

  15. Workup

  16. Medscape.com

  17. Treatment

  18. Literature:

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