Takotsubo cardiomyopathy in two female patients: two case reports

Tako-tsubo cardiomyopathy (idiopathic apical ballooning syndrome or ampulla cardiomyopathy) has recently been described. First recognised in Japanese patients, tako-tsubo refers to the end-systolic appearance of the left ventricle on ventriculography and its resemblance to the round bottomed, narrow necked Japanese fishing pots used to trap octopus

We present two cases of female caucasian patients aged 40 and 63 years respectively admitted following severe stressful events who met the diagnostic criteria of tako-tsubo cardiomyopathy, namely acute chest pain, transient akinesis or dyskinesia of the left ventricle, new dynamic electrocardiogram changes and no significant epicardial coronary artery disease in the absence of recent head trauma, intracranial bleeding, phaeochromocytoma, myocarditis and hypertrophic cardiomyopathy. Both had elevated cardiac biomarkers. Characteristically the condition is transient and the abnormal akinesia/dyskinesia of the left ventricle has been observed to normalise within 1-month as in our patients who made full recoveries.

Patients with tako-tsubo cardiomyopathy present with features consistent with an acute coronary syndrome and as such the syndrome is probably under-diagnosed. It may be with the introduction of primary percutaneous coronary intervention more cases are identified, sparing patients the risks of unnecessary thrombolytic therapy. Tako-tsubo cardiomyopathy should be considered in all patients presenting with acute onset chest pain and elevated cardiac biomarkers.