Thank you Dr. Shah for an excellent case of Stress-Induced Cardiomyopathy!

Learning Points:

• Pathophysiology: not well understood, however postulated mechanisms include catecholamine excess, coronary artery spasm and microvascular dysfunction
• Mostly associated with physical or emotional stress preceding onset of chest pain
• Clinical presentation: most common symptom is acute substernal chest pain followed by dyspnea, syncope, heart failure, malignant arrhythmias and cardiogenic shock
• Diagnostic criteria:
  • 1) transient hypokinesis, akinesis or dyskinesia of the LV mid segments with or without apical involvement
  • 2) no obstructive CAD or acute plaque rupture
  • 3) new EKG abnormalities or troponin elevation
  • 4) no pheochromocytoma or mypcarditis

• Workup: serial troponins, BNP, EKG, 2D echo, cardiac MRI, radionuclide myocardial perfusion imaging study
• Treatment: generally a transient disorder  thus requires only supportive therapy, however standard management for heart failure, cardiogenic shock or other complications

Click here for a great review of Takotsubo Cardiomyopathy