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Introduction
Takotsubo cardiomyopathy is a transient left ventricular (LV) dysfunction, typically triggered by severe emotional or physical stress, which is usually followed by a complete recovery. The syndrome was originally described in Japan 20 years ago, characterised by cardiac-type chest pain and ECG changes, mimicking anterior myocardial infarction and apical aneurysmal dilatation of the left ventricle. This results in a systolic appearance of the ventricle resembling the shape of a takotsubo: a pot with a narrow neck and round bottom used to trap octopi. 1 An increasing recognition of this disorder in the last few years has resulted in a more detailed description of the clinical features and pathophysiology. Due to the novelty of this disease and the rapid increase in literature reports, there has been a great deal of confusion over the nomenclature of takotsubo cardiomyopathy. The most commonly encountered names include apical ballooning syndrome, broken heart syndrome, stress-induced cardiomyopathy and ampulla cardiomyopathy. 2 Currently, it is advocated that takotsubo cardiomyopathy should be included in differential diagnosis in patients presenting with symptoms of acute coronary syndrome following severe emotional or physical stress. Although the cause remains largely unknown, a number of recent studies have suggested several different possible mechanisms of pathogenesis, and hence a degree of controversy exists. The aim of this paper is to provide a review of the current literature on this recently described cardiomyopathy focusing on clinical features, diagnosis, pathophysiology and treatment.
Clinical features
Epidemiology
Since its description in 1990, takotsubo cardiomyopathy has been increasingly reported in Japan and other Asian countries and Europe, North America and Australia. 2 To date, there have been more than 1000 reports published on takotsubo cardiomyopathy. It is estimated that takotsubo cardiomyopathy accounts for ~2% of all suspected acute coronary syndromes with 90% of the cases being in postmenopausal women. 2-5 Interestingly, the majority of male patients who developed takotsubo cardiomyopathy were hospital inpatients, which suggests a role of physical stress in the pathogenesis, but may also suggest that men who do develop the syndrome are more likely to die suddenly and thus do not survive till diagnosis. 6 The average age at diagnosis is 68; however, a few cases have been described in paediatric patients. 7 8
Presentation and diagnosis
Patients usually present with...