apical ballooning syndrome

Q: In which country was Takotsubo cardiomyopathy first described? - select one

A) America

B) Britain

C) Canada

D) Denmark

E) Japan

Answer: E

This question aims to make students understand the importance of nomenclature for underlying pathophysiology. The well-known name for Stress cardiomyopathy is tаkοtѕսbo cardiomyopathy after it was first described in Japan in 1990. The other names used are broken heart syndrome and apical ballooning syndrome.

Tаkοtѕսbo is a Јараոеsе term for an octopus trap, which has a shape similar to the systolic apical ballooning appearance of the Left Ventricle (LV) in the typical form of this cardiomyopathy. The syndrome is characterized by "transient" regional systolic dysfunction, principally of the left ventricle (LV), which mimics myocardial infarction (MΙ) with troponin-positive and/or ST-elevation but without angiographic evidence of obstructive coronary artery disease or any acute plaque rupture. The regional wall motion abnormality mostly extends beyond the territory perfused by a single epicardial coronary artery. 

In typical presentation, attention should be given to two aspects during echocardiography. The mid and apical segments of the LV are hypokinetic or akinetic, and there is hyperkinesis of the basal walls. A variant as a midventricular type and other variants have also been described as case reports.

#cardiology

References:

1. Sato, H, Taiteishi, et al. Takotsubo-type cardiomyopathy due to multivessel spasm. In: Clinical aspect of myocardial injury: From ischemia to heart failure, Kodama, K, Haze, K, Hon, M (Eds), Kagakuhyouronsha, Tokyo 1990. p.56.

2. Kurowski V, Kaiser A, von Hof K, et al. Apical and midventricular transient left ventricular dysfunction syndrome (tako-tsubo cardiomyopathy): frequency, mechanisms, and prognosis. Chest 2007; 132:809.

3. Prasad A, Dangas G, Srinivasan M, et al. Incidence and angiographic characteristics of patients with apical ballooning syndrome (takotsubo/stress cardiomyopathy) in the HORIZONS-AMI trial: an analysis from a multicenter, international study of ST-elevation myocardial infarction. Catheter Cardiovasc Interv 2014; 83:343.

4. Crea F, Iannaccone G, La Vecchia G, Montone RA. An update on the mechanisms of Takotsubo syndrome: "At the end an acute coronary syndrome". J Mol Cell Cardiol. 2024 Jun;191:1-6. doi: 10.1016/j.yjmcc.2024.04.009. Epub 2024 Apr 18. PMID: 38641224.