takotsubo cardiomyopathy

Q: Anticoagulation in patients with stress (takotsubo) cardiomyopathy with 'clean coronaries' is an absolute contraindication? 

A) True
B) False


Answer: B

Stress cardiomyopathy, famously also known as takotsubo cardiomyopathy or 'broken heart syndrome', is a transient condition and mostly recovers with supportive treatment. But it requires anticoagulation despite clean coronaries on cardiac angiogram under two conditions:

1. If there is an intraventricular thrombus present, or
2. if  LV ejection fraction is less than 30 percent despite no thrombus.

Length of anticoagulation is usually 12 weeks but may vary from patient to patient depending on clinical and echocardiographic recovery.


#cardiology


References: 

1. Heik SC, Kupper W, Hamm C, et al. Efficacy of high dose intravenous heparin for treatment of left ventricular thrombi with high embolic risk. J Am Coll Cardiol 1994; 24:1305. 

2. Templin C, Ghadri JR, Diekmann J, et al. Clinical Features and Outcomes of Takotsubo (Stress) Cardiomyopathy. N Engl J Med 2015; 373:929.