Stress-induced cardiomyopathy, or Takotsubo syndrome: a condition that mimics acute coronary syndrome

Takotsubo syndrome, or stress-induced cardiomyopathy, is a relatively new diagnosis. This syndrome mainly affects postmenopausal women and is often preceded by a stressful event that triggers a clinical picture that is indistinguishable from acute coronary syndrome. Both have similar electrocardiographic findings (ST-segment elevation, corrected QT interval prolongation, T-wave inversion) and raised levels of markers of myocardial damage (although the elevation is less marked in Takotsubo syndrome). Coronary angiography fails to demonstrate significant obstruction. Takotsubo syndrome is characterized by transient systolic dysfunction, with contractile abnormalities in the apical and middle sections of the ventricle wall and compensatory hyperkinesis of the base of the heart. The resulting morphology typifies the syndrome and gives rise to another name for the syndrome: apical ballooning. The etiology and pathogenesis of this syndrome are poorly understood, although the most widely accepted hypothesis is that massive release of catecholamines is the culprit. Another popular theory blames the rupture of an atheromatous plaque in the anterior descending coronary artery, with spontaneous lysis of the thrombus covering the plaque. Prognosis is excellent in takotsubo syndrome, differentiating it from acute coronary syndrome. Associated in-hospital mortality is very low.