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Tako-Tsubo –Like Transient Left Ventricular Dysfunction

2003; Lippincott Williams & Wilkins; Volume: 107; Issue: 18 Linguagem: Norueguês

10.1161/01.cir.0000062608.53625.dc

1524-4539

John P. Girod, Adrian W. Messerli, Frank Zidar, W.H. Wilson Tang, Sorin J. Brener,

Cardiovascular Function and Risk Factors

HomeCirculationVol. 107, No. 18Tako-Tsubo–Like Transient Left Ventricular Dysfunction Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessReview ArticlePDF/EPUBTako-Tsubo–Like Transient Left Ventricular Dysfunction John P. Girod, DO, Adrian W. Messerli, MD, Frank Zidar, MD, W. H. Wilson Tang, MD and Sorin J. Brener, MD John P. GirodJohn P. Girod From the Cleveland Clinic Foundation, Cleveland, Ohio. , Adrian W. MesserliAdrian W. Messerli From the Cleveland Clinic Foundation, Cleveland, Ohio. , Frank ZidarFrank Zidar From the Cleveland Clinic Foundation, Cleveland, Ohio. , W. H. Wilson TangW. H. Wilson Tang From the Cleveland Clinic Foundation, Cleveland, Ohio. and Sorin J. BrenerSorin J. Brener From the Cleveland Clinic Foundation, Cleveland, Ohio. Originally published13 May 2003https://doi.org/10.1161/01.CIR.0000062608.53625.DCCirculation. 2003;107:e120–e121A 68-year-old woman presented with mild chest pressure typical of myocardial ischemia. The initial ECG revealed normal sinus rhythm with ST-segment elevations in leads V2 through V5 (Figure 1). Troponin T level was 3.4 ng/mL (normal <0.01 ng/mL), and creatinine kinase level was 250 U/L (normal <220 U/L). The patient underwent emergency coronary angiography, which demonstrated minimal atherosclerotic disease. However, contrast left ventriculography demonstrated marked akinesis of the mid and distal segments of all walls, with compensatory hyperkinesis of the base (Figure 2). Transthoracic echocardiography also demonstrated akinesis of the midanterior, apical septal, apical inferior, apical lateral, and apical anterior segments. The right ventricle was normal in size and function. No valvular abnormalities were observed. The patient remained clinically and hemodynamically stable during her 3-day hospitalization. Serial cardiac markers trended down. Viral titers, iron studies, thyroid function tests, and serum protein electrophoresis were noncontributory. Her discharge medications included an aspirin, an ACE inhibitor, a β-blocker, and a statin. Repeat echocardiography 1 month later demonstrated complete resolution of the regional systolic dysfunction. Download figureDownload PowerPointFigure 1. Twelve-lead ECG. Sinus rhythm with 1- to 2-mm ST elevation in leads V2 through V5.Download figureDownload PowerPointFigure 2. Contrast left ventriculogram. End-diastolic (A) and end-systolic (B) left ventriculograms illustrating apical asynergy.Tako-tsubo–like (Japanese word for octopus-catcher, Figure 3) left ventricular dysfunction is an enigmatic cardiomyopathy, characterized by marked apical asynergy in the absence of significant coronary disease. Typically, these patients are elderly women who present with mild to moderate chest pain, have ST-segment elevation in leads V3 through V6, and have a modest rise in cardiac markers. The exact etiology remains unknown, but the transient dysfunction may be secondary to microvascular spasm or regional myocarditis. Download figureDownload PowerPointFigure 3. An antique tako-tsubo.The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke's Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke's Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.FootnotesCorrespondence to Sorin J. Brener MD, FACC, Division of Cardiology/F25, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195. 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May 13, 2003Vol 107, Issue 18 Advertisement Article InformationMetrics https://doi.org/10.1161/01.CIR.0000062608.53625.DCPMID: 12742971 Originally publishedMay 13, 2003 PDF download Advertisement