Stress-induced cardiomyopathy

Keyword

Stress-induced cardiomyopathy

Takotsubo cardiomyopathy

Apical ballooning syndrome

Ampulla cardiomyopathy

Definition

• 급격한 감정 또는 신체상의 stress 이후 LV systolic dysfunction이 acute, reversible하게 나타나는 상태.
• 주로 mid & apical segment를 침범.
• obstructive epicardial coronary artery disease가 아님에도 ECG 상에서 ischemia 나 myocardial injury 소견을 보일 수 있음.

Diagnosis

<By Mayo Clinic diagnostic criteria>

1. Transient contractile dysfunction of the mid-LV segments with or without apical involvement
2. Absence of obstructive coronary disease or angiographic evidence of acute plaque rupture
3. new ECG abnormalities (either ST-segment elevation, T-wave inversion, or both) or elevated cardiac troponin
4. Absence of a pheochromocytoma or myocarditis

Pathophysiology

스트레스에 의한 catecholamine surge

Treatment

• Generally recover spontaneously
• Currently, no proven therapy

Prognosis

약 40%의 환자가 congestive heart failure 발생.

약 10% 정도의 소수 환자에서는 acute cardiogenic shock이나 major hemodynamic compromise 발생.

Reference

Prasad A, Madhavan M, Chareonthaitawee P: Cardiac sympathetic activity in stress-induced (takotsubo) cardiomyopathy, Nat Rev Cardiol 6:430, 2009.