Takotsubo cardiomyopathy. Diagnosis and therapy

Takotsubo cardiomyopathy exhibits similar symptoms to acute coronary syndrome (ACS) but without significant coronary disease. It mainly affects postmenopausal women. Patients have apical akinesia of the left or both ventricles with hyperkinesia of the basal segments, which causes ventricular dysfunction. The underlying etiologies are still largely unknown. An elevated catecholamine level, lack of estrogen, disturbed myocardial fatty acid metabolism, disturbed myocardial microcirculation and plaque rupture with spontaneous thrombolysis are potentially critical mechanisms in inducing prolonged stunned myocardium. The most frequently described trigger in the literature is sudden, strong emotional stress. Supportive therapy with aspirin, beta blockers and angiotensin-converting enzyme (ACE) inhibitors can reverse the abnormal kinetics in this disease. However, all the complications of acute myocardial infarction, including cardiogenic shock and ventricular fibrillation, may occur.