Tako-tsubo cardiomyopathy

A 48-year-old woman presented to her local hospital with chest pain. Her electrocardiogram showed incomplete right bundle branch block, diffuse ST segment elevation and QTc prolongation. Shortly after admission, she became hypotensive and was referred for a coronary angiogram. Her coronary arteries were normal, but left ventriculography showed morphological changes typical of apical ballooning, as found in tako-tsubo cardiomyopathy. An echocardiogram confirmed complete akinesis of the left ventricular apex, with hyperkinesis of basal segments and an ejection fraction of 35% to 40%. Dynamic left ventricular outflow tract obstruction was also noted. After temporary support with intra-aortic balloon counterpulsation, fluids and noradrenaline, she recovered promptly. The present paper reviews the characteristic features of tako-tsubo cardiomyopathy.