Broken heart syndrome or takotsubo cardiomyopathy


Takotsubo cardiomyopathy is an acute cardiac syndrome that mimics ST segment elevation myocardial infarction. It is characterized by transient local contractility disturbances as akinesis of the apical and middle segments of the left ventricle concurrent with hyperkinesis of its basal portions in the absence of significant coronary artery changes. A description of 2 clinical cases and a review of literature on this rare myocardial disease are given.


  1. Dote K., Sato H., Tateishi H. et al. Myocardial stunning due to simultaneous multivessel coronary spasms: a review of 5 cases. J. Cardiol. 1991; 21: 203-214.
  2. Desmet W. J., Adriaenssens B. F., Dens J. A. Apical ballooning of the left ventricle: first series in white patients. Heart 2003; 89: 1027-1031.
  3. Bybee K. A., Prasad A., Barsness G. W. et al. Clinical characteristics and thrombolysis in myocardial infarction frame counts in women with transient left ventricular apical ballooning syndrome. Am. J. Cardiol. 2004; 94: 343-346.
  4. Bybee K. A., Kara T., Prasad A. et al. Systematic review transient left ventricular apical ballooning: a syndrome that mimics ST-elevation myocardial infarction. Ann. Intern. Med. 2004; 141: 858-865.
  5. Gianni M., Dentali F., Grandi A. M. et al. Apical ballooning syndrome or Takotsubo cardiomyopathy: a systematic review. Eur. Heart J. 2006; 27: 1523-1529.
  6. Sharkey S. W., Lesser J. R., Zenovich A. C. et al. Acute and reversible cardiomyopathy provoked by stress in women from the United States. Circulation 2005; 111: 472-479.
  7. Ito K., Sugihara H., Katoh S. et al. Assessment of Takotsubo (ampulla) cardiomyopathy using 99m Tc-tetrofosmin myocardial SPECT-comparison with acute coronary syndrome. Ann. Nucl. Med. 2003; 17: 115-122.
  8. Akashi Y. J., Musha H., Nakazawa K., Miyake F. Plasma brain natriuretic peptide in Takotsubo cardiomyopathy. Quart. J. Med. 2004; 97: 599-607.
  9. Akashi Y. J., Nakazawa K., Sakakibara M. et al. The clinical features of Takotsubo cardiomyopathy. Quart. J. Med. 2003; 96(8): 563-573.
  10. Von Korn H., Jiangtao Yu., Lotze U. et al. Takotsubo like cardiomyopathy: specific ECG Findings, characterization and clinical findings in a European single center. Cardiology 2009; 112: 42-48.
  11. Ogura R., Hiasa Y., Takahashi T. et al. Specific findings of the standard 12-lead ECG in patients with Takotsubo cardiomyopathy: Comparison with the findings of acute anterior myocardial infarction. Circ. J. 2003; 67: 687-690.
  12. Jim M. H., Chan A. O., Tsui P. T. et al. A new ECG criterion to identify Takotsubo cardiomyopathy from anterior myocardial infarction: role of inferior leads. Heart Vessels 2009; 24(2): 124-130.
  13. Prasad A., Lerman A., Rihal C. S. Apical ballooning syndrome (Takotsubo or stress cardiomyopathy): a mimic of acute myocardial infarction. Am. Heart J. 2008; 155: 408-417.
  14. Kardasz I., De Caterina R. Myocardial infarction with normal coronary arteries: a conundrum with multiple aetiologies and variable prognosis: an update. J. Intern. Med. 2007; 261(4): 330-348.
  15. Chandrasekaran B., Kurbaan A. S. Myocardial infarction with angiographically normal coronary arteries. J. R. Soc. Med. 2002; 95(8): 398-400.
  16. Facciorusso A., Vigna C., Amico C. et al. Prevalence of Tako-Tsubo syndrome among patients with suspicion of acute coronary syndrome referred to our centre. Int. J. Cardiol. 2009; 134(2): 255-259.
  17. Moreo A., De Chiara B., Possa M. et al. Functional derangement and cardiac innervation in the apical ballooning syndrome: a 123I-meta-iodobenzylguanidine scintigraphic and dobutamine stress echocardiographic study. J. Cardiovasc. Med. 2007; 8(3): 205-209.
  18. Kazuki I., Hiroki S., Shuji K. et al. Assessment of Takotsubo (ampulla) cardiomyopathy using 99mTc-tetrofosmin myocardial SPECT: comparison with acute coronary syndrome. Ann. Nucl. Med. 2003; 17(2): 115-122.
  19. Abe Y., Kondo M., Matsuoka R. et al. Assessment of clinical features in transient left ventricular apical ballooning. J. Am. Coll. Cardiol. 2003; 41: 737-742.
  20. Ibanez B., Navarro F., Farre J. et al. Tako-tsubo syndrome associated with a long course of the left anterior descending coronary artery along the apical diaphragmatic surface of the left ventricle. Rev. Esp. Cardiol. 2004; 57: 209-216.
  21. Ibanez B., Navarro F., Cordoba M. et al. Takotsubo transient left ventricular apical ballooning: is intravascular ultrasound the key to resolve the enigma? Heart 2005; 91(1): 102-104.
  22. Verheugt F. W., Gersh B. J., Armstrong P. W. Aborted myocardial infarction: a new target for reperfusion therapy. Eur. Heart J. 2006; 27: 901-904.
  23. Ibanez B., Choi B. G., Navarro F., Ferre J. Tako-tsubo syndrome: a form of spontaneous aborted myocardial infarction? Eur. Heart J. 2006; 27(12): 1509-1510.
  24. Wittstein I. S., Thiemann D. R., Lima J. A. C. et al. Neurohumoral features of myocardial stunning due to sudden emotional stress. N. Engl. J. Med. 2005; 352(6): 539-548.
  25. Lenders J. W., Eisenhofer G., Mannelli M., Pacak K. Phaeochromocytoma. Lancet 2005; 366(9486): 665-675.
  26. Akashi Y. J., Barbaro G., Sakurai T. et al. Cardial autonomic imbalance in patients with reversible ventricular dysfunction Takotsubo cardiomyopathy. Quart. J. Med. 2007; 100: 335- 343.
  27. American College of Cardiology. Heart disease and stroke statistics: 2007 update at a glance. downloadable/heart/1166711577754HS_StatsInside Accessed November 5, 2008.
  28. Joseph J., Gilbert E. M. The sympathetic nervous system in chronic heart failure. Progr. Cardiovasc. Dis. 1998; 41(Suppl. 1): 9-16.
  29. Packer M. Beta-adrenergic blockade in chronic heart failure: principles, progress and practice. Prog. Cardiovasc. Dis. 1998; 41(Suppl. 1): 39-52.
  30. Waagstein F., Hjalmarson A., Varnauskas E., Wallentin I. Effect of chronic beta-adrenergic receptor blockade in congestive cardiomyopathy. Br. Heart J. 1975; 37: 1022-1036.
  31. Omerovic E. Did Jesus die of a 'broken heart'? Eur. J. Heart Fail. 2009; 11(8): 729-731.
  32. Donohue D., Movahed M. R. Clinical characteristics, demographics, and prognosis of transient left ventricular apical ballooning syndrome. Heart Fail. Rev. 2005; 10: 311-316.
  33. Lee W. L., Miao L. F., Chan H. W., Chen M. Z. Takotsubo syndrome with transient complete atrioventricular block. Chin. Med. J. 2006; 119: 73-76.
  34. Kurisu S., Inoue I., Kawagoe T. et al. Left ventricular apical thrombus formation in a patient with suspected Takotsubo-like left ventricular dysfunction. Circ. J. 2003; 67: 556-558.
  35. Tibrewala A. V., Moss B. N., Cooper H. A. A rare case of Takotsubo cardiomyopathy complicated by a left ventricular thrombus. South. Med. J. 2006; 99: 70-73.
  36. Sasaki N., Kinugawa T., Yamawaki M. et al. Transient left ventricular apical ballooning in a patient with bicuspid aortic valve created a left ventricular thrombus leading to acute renal infarction. Circ. J. 2004; 68: 1081-1083.
  37. Barrera-Ramirez C. F., Jimenez-Mazuecos J. M., Alfonso F. Apical thrombus associated with left ventricular apical ballooning. Heart 2003; 89: 927-935.
  38. Villareal R. P., Achari A., Wilansky S., Wilson J. M. Anteroapical stunning and left ventricular outflow tract obstruction. Mayo Clin. Proc. 2001; 76: 79-84.
  39. Tsuchihashi K., Ueshima K., Uchida T. et al. Transient left ventricular apical ballooning without coronary artery stenosis: a novel heart syndrome mimicking acute myocardial infarction. Angina Pectoris-Myocardial Infarction Investigations in Japan. J. Am. Coll. Cardiol. 2001; 38: 11-15.
  40. Kurisu S., Sato H., Kawagoe T. et al. Tako-tsubo-like left ventricular dysfunction with ST segment elevation: a novel cardiac syndrome mimicking acute myocardial infarction. Am. Heart J. 2002; 143: 448-455.
  41. Akashi Y. J., Goldstein D. S., Barbaro G., Ueyama T. Takotsubo cardiomyopathy: a new form of acute, reversible heart failure. Circulation 2008; 118: 2754-2766.
  42. Elesber A. A., Prasad A., Lennon R. J. et al. Four-year recurrence rate and prognosis of the apical ballooning syndrome. J. Am. Coll. Cardiol. 2007; 50: 448-457.
  43. Derrick D. The "Broken Heart Syndrome": Understanding Takotsubo cardiomyopathy. Crit. Care Nurse 2009; 29(1): 49- 57.
  44. Bybee K. A., Prasad A. Stress-related cardiomyopathy syndromes. Circulation 2008; 118: 397-409.
  45. Fazio G., Pizzuto C., Barbaro G. et al. Chronic pharmacological treatment in Takotsubo cardiomyopathy. Int. J. Cardiol. 2008; 127(1): 121-123.
  46. Дупляков Д. В. Шарообразное расширение верхушки левого желудочка или "Tako-tsubo" кардиомиопатия. Кардиология 2004; 11: 97-99.
  47. Шустов С. Б., Барсуков А. В., Pichler M. и др. Стресс-индуцированная кардиомиопатия (синдром tako-tsubo) у пациентки с артериальной гипертензией. Артер. гипертенз. 2006; 1: 325-330.
  48. Хорикова Е. Н., Артемова Е. В., Нуднов Н. В., Остроумов Е. Н. Диагностика ампульной кардиомиопатии с помощью перфузионной томосцинтиграфии миокарда. Рос. мед. журн. 2006; 3: 3-7.
  49. Гиляров М. Ю., Сафарова М. С., Сыркин А. Л. Стресс-индуцированная кардиомиопатия (синдром Тако-цубо). Кардиол. и серд.-сосуд. хир. 2008; 2: 69-75.
  50. Аронов Д. М. Кардиомиопатия типа Tako-tsubo, ее происхождение и варианты. Кардиология 2008; 10: 51-57.
  51. Лиманкина И. Н. Кардиомиопатия Такоцубо. Вестн. аритмол. 2009; 56: 48-58.
  52. Bassand J. P., Hamm C. W., Ardissino D. et al. Guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes. The Task Force for the Diagnosis and Treatment of Non-ST-Segment Elevation Acute Coronary Syndromes of the European Society of Cardiology. Eur. Heart J. 2007; 28(13): 1598-1660.
  53. Anderson J. L., Adams C. D., Antman E. M. et al. American College of Cardiology; American Heart Association Task Force on Practice Guidelines. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction. J. Am. Coll. Cardiol. 2007; 50: e1-e15.
  54. Maron B. J., Towbin J. A., Thiene G. et al. Contemporary definitions and classification of the cardiomyopathies. An American Heart Association Scientific Statement From the Council on Clinical Cardiology, Heart Failure and Transplantation Committee; Quality of Care and Outcomes Research and Functional Genomics and Translational Biology Interdisciplinary Working Groups; and Council on Epidemiology and Prevention. Circulation 2006; 113: 1807-1816.

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