Tako-Tsubo Syndrome Triggered by a Fibroscopy: Case Report

Tako-Tsubo cardiomyopathy (TTC) is defined as a transient left ventricle (LV) dysfunction triggered by a stressful event [1]. It was first identified in Japan in the 1990s and was named after Japanese octopus traps (takotsubo) that are shaped similarly to the heart of affected individuals in its typical form [2]. TTC is also called "stress cardiomyopathy" or "apical ballooning syndrome" and mostly affects elderly women [3]. It classically involves apical ballooning due to apical akinesis or hypokinesis with preserved or hypercontractile basal segments, but there are other types of LV involvement that are rare: inverted, midventricular, or basal TTC. The genesis of TTC is complicated and is subject to numerous hypotheses, some of which are still being investigated [3-4]. One of the hypotheses that has long been debated is the cardiovascular response to a sudden surge of circulating catecholamines. However, emotional, physiological, and even environmental stressors are thought to be involved in its genesis. American Heart Association described TTC as a secondary cardiomyopathy [5-6]. Transthoracic echocardiography (TTE) is the method of choice for the evaluation of LV function and visualization of symmetric regional wall motion abnormalities (WMA) [7]. Takotsubo patients, usually, have a good improvement in LV function, making it a benign condition most of the time [6]. Although the prognosis is favorable, these patients require treatment and close monitoring in the acute phase to prevent fatal complications. Tako-tsubo syndrome should be known by all practitioners and considered as a differential diagnosis in patients presenting with acute coronary syndrome (ACS), especially after physical or emotional stress.