Skip to main content
SpringerLink
Log in

Stress-Induced Cardiomyopathy

  • Published:
Current Cardiovascular Imaging Reports Aims and scope Submit manuscript

Abstract

Stress-induced cardiomyopathy (SIC) is an increasingly recognized disease entity and is accepted as a unique form of reversible cardiomyopathy. Typical apical ballooning precipitated by emotional stress with clinical features mimicking acute coronary syndrome and rapid recovery was a hallmark of SIC. Along with cumulative experiences, new features are well appreciated. These include atypical ballooning patterns (mid-ventricular and basal ballooning), contribution of physical stressors (acute medical illnesses and routine diagnostic and therapeutic procedures including surgery) to the development of SIC, and development of serious complications such as right ventricular dysfunction, thrombus formation, and left ventricular outflow tract obstruction with significant mortality rate and occasional recurrence, representing diverse clinical spectrum of SIC. Although the exact mechanism and standard treatment of SIC has not been established, physicians’ vigilance is needed for prompt diagnosis and adequate treatment for this potentially fatal disorder. Echocardiography can play a role as an easy and noninvasive imaging modality.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of importance

  1. Maron BJ, Towbin JA, 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;113:1807–16.

    Article  PubMed  Google Scholar 

  2. Gianni M, Dentali F, Grand AM, et al. Apical ballooning syndrome or takotsubo cardiomyopathy: a systemic review. Eur Heart J. 2006;27:1523–9.

    Article  PubMed  Google Scholar 

  3. •• Bybee KA, Prasad A. Stress-related cardiomyopathy syndromes. Circulation. 2008;118:397–409. An excellent review article.

    Article  PubMed  Google Scholar 

  4. •• Zeb M, Sambu N, Scott P, Curzen N. Takotsubo cardiomyopathy: a diagnostic challenge. Postgrad Med J. 2011;87:51–59. Another outstanding review article.

    Article  PubMed  Google Scholar 

  5. 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. J Am Coll Cardiol. 2001;38:11–8.

    Article  PubMed  CAS  Google Scholar 

  6. 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;143:448–55.

    Article  PubMed  Google Scholar 

  7. Bybee KA, Kara T, Prasad A, et al. Transient left ventricular apical ballooning: a syndrome that mimics ST-segment elevation myocardial infarction. Ann Intern Med. 2004;141:858–65.

    PubMed  Google Scholar 

  8. Hurst RT, Askew JW, Reuss CS, et al. Transient midventricular ballooning syndrome: a new variant. J Am Coll Cardiol. 2006;48:579–83.

    Article  PubMed  Google Scholar 

  9. Guerrero J, Majid A, Ernst A. Cardiogenic shock secondary to Tako-tsubo syndrome after debridement of malignant endobronchial obstruction. Chest. 2009;135:217–20.

    Article  PubMed  Google Scholar 

  10. Kurisu S, Inoue I, Kawagoe T, et al. Persistent left ventricular dysfunction in takotsubo cardiomyopathy after pacemaker implantation. Circ J. 2006;70:641–4.

    Article  PubMed  Google Scholar 

  11. Jensen JB, Malouf JF. Takotsubo cardiomyopathy following cholecystectomy: a poorly recognized cause of acute reversible left ventricular dysfunction. Int J Cardiol. 2006;106:390–1.

    Article  PubMed  Google Scholar 

  12. Gavish D, Rozenman Y, Hafner R, et al. Takotsubo cardiomyopathy after general anesthesia for eye surgery. Anesthesiology. 2006;105:621–3.

    Article  PubMed  Google Scholar 

  13. Lentschener C, Vignaux O, Spaulding C, et al. Early postoperative tako-tsubo-like left ventricular dysfunction: transient left ventricular apical ballooning syndrome. Anesth Analg. 2006;103:580–2.

    Article  PubMed  Google Scholar 

  14. Jabaudon M, Bonnin M, Bolandard F, et al. Takotsubo syndrome during induction of general anaesthesia. Anaesthesia. 2007;62:519–23.

    Article  PubMed  CAS  Google Scholar 

  15. Park JH, Kang SJ, Song JK, et al. Left ventricular apical ballooning due to severe physical illness in patients admitted to the medical ICU. Chest. 2005;128:296–302.

    Article  PubMed  Google Scholar 

  16. • Lee PH, Song JK, Sun BJ, et al. Outcomes of patients with stress-induced cardiomyopathy diagnosed by echocardiography in a tertiary referral hospital. J Am Soc Echocardiogr. 2010;23:766–71. Clinical features of stress-induced cardiomyopathy triggered by physical stressors are well described.

    Article  PubMed  Google Scholar 

  17. Denney SD, Lakkireddy DR, Khan IA. Long QT syndrome and torsade de pointes in transient left ventricular apical ballooning syndrome. Int J Cardiol. 2005;100:499–501.

    Article  PubMed  Google Scholar 

  18. Okada T, Miyata S, Hashimoto K, et al. Takotsubo cardiomyopathy associated with torsade de pointes and long QT interval: a case report. J Cardiol. 2007;50:83–8.

    PubMed  Google Scholar 

  19. Akashi YJ, Tejima T, Sakurada H, et al. Left ventricular rupture associated with Takotsubo cardiomyopathy. Mayo Clin Proc. 2004;79:821–4.

    Article  PubMed  Google Scholar 

  20. Sakai K, Ochiai H, Katayama N, et al. Ventricular septal perforation in a patient with takotsubo cardiomyopathy. Circ J. 2005;69:365–7.

    Article  PubMed  Google Scholar 

  21. Sacha J, Maselko J, Wester A, et al. Left ventricular apical rupture caused by takotsubo cardiomyopathy – comprehensive pathological heart investigation. Circ J. 2007;71:982–5.

    Article  PubMed  Google Scholar 

  22. Shinozaki K, Tamura A, Abe Y, et al. Left ventricular free wall rupture in takotsubo cardiomyopathy. Int J Cardiol. 2007;115:e3–4.

    Article  PubMed  Google Scholar 

  23. Haghi D, Athanasiadis A, Papavassiliu T, et al. Right ventricular involvement in Takotsubo cardiomyopathy. Eur Heart J. 2006;27:2433–9.

    Article  PubMed  Google Scholar 

  24. Prasad A. Apical ballooning syndrome. An important differential diagnosis of acute myocardial infarction. Circulation. 2007;115:e56–9.

    Article  PubMed  Google Scholar 

  25. Bybee KA, Prasad A, Barsness GW, et al. Clinical characteristics and thrombolysis in myocardial infarction frame counts in women with transient left ventricular apical ballooning syndrome. Am J Cardiol. 2004;94:343–6.

    Article  PubMed  Google Scholar 

  26. Sharkey SW, Lesser JR, Zenovich AG, et al. Acute and reversible cardiomyopathy provoked by stress in women from the United States. Circulation. 2005;111:472–9.

    Article  PubMed  Google Scholar 

  27. Elian D, Osherov A, Matetzky S, et al. Left ventricular apical ballooning syndrome: not an uncommon variant of acute myocardial infarction in women. Clin Cardiol. 2006;29:9–12.

    Article  PubMed  Google Scholar 

  28. Kurowski V, Kaiser A, von Hof K, et al. Apical and midventricular transient left ventricular dysfunction syndrome (tako-tsubo cardiomyopathy): frequency, mechanisms, and prognosis. Chest. 2007;132:809–16.

    Article  PubMed  Google Scholar 

  29. Van de Walle SO, Gevaert SA, Gheeraert PJ, et al. Transient stress-induced cardiomyopathy with an “inverted Takotsubo” contractile pattern. Mayo Clin Proc. 2006;81:1499–502.

    Article  PubMed  Google Scholar 

  30. Parodi G, Del Pace S, Salvadori C, et al. Left ventricular apical ballooning syndrome as a novel cause of acute mitral regurgitation. J Am Coll Cardiol. 2007;50:647–9.

    Article  PubMed  Google Scholar 

  31. Sasaki O, Nishioka T, Akima T, et al. Association of Takotsubo cardiomyopathy and long QT syndrome. Circ J. 2006;70:1220–2.

    Article  PubMed  Google Scholar 

  32. Samuelov-Kinori L, Kinori M, Kogan Y, et al. Takotsubo cardiomyopathy and QT interval prolongation: who are the patients at risk for torsades de pointes? J Electrocardiol. 2009;42:353–7.

    Article  PubMed  Google Scholar 

  33. Cherian J, Angelis D, Filiberti A, Saperia G. Recurrence of stress-induced (Takotsubo) cardiomyopathy. Cardiology. 2007;108:144–6.

    Article  PubMed  Google Scholar 

  34. Shimizu M, Kato Y, Masai H, et al. Recurrent episodes of takotsubo-like transient left ventricular apical ballooning occurring in different regions: a case report. J Cardiol. 2006;48:101–7.

    PubMed  Google Scholar 

  35. Elesber AA, Prasad A, Lennon RJ, et al. Four-year recurrence rate and prognosis of the apical ballooning syndrome. J Am Coll Cardiol. 2007;50:448–52.

    Article  PubMed  Google Scholar 

  36. Teraoka K, Kiuchi S, Takada N, et al. Images in cardiovascular medicine. No delayed enhancement on contrast magnetic resonance imaging with Takotsubo cardiomyopathy. Circulation. 2005;111:e261–2.

    Article  PubMed  Google Scholar 

  37. Mitchell JH, Hadden TB, Wilson JM, et al. Clinical features and usefulness of cardiac magnetic resonance imaging in assessing myocardial viability and prognosis in Takotsubo cardiomyopathy (transient left ventricular apical ballooning syndrome). Am J Cardiol. 2007;100:296–301.

    Article  PubMed  Google Scholar 

  38. Haghi D, Fluechter S, Suselbeck T, et al. Cardiovascular magnetic resonance findings in typical versus atypical forms of the acute apical ballooning syndrome (Takotsubo cardiomyopathy). Int J Cardiol. 2007;120:205–11.

    Article  PubMed  Google Scholar 

  39. Kawai S, Kitabatake A, Tomoike H. Takotsubo Cardiomyopathy Group. Guidelines for diagnosis of takotsubo (ampulla) cardiomyopathy. Circ J. 2007;71:990–2.

    Article  PubMed  Google Scholar 

  40. Crimi E, Baggish A, Leffert L, et al. Acute reversible stress-induced cardiomyopathy associated with cesarean delivery under spinal anesthesia. Circulation. 2008;117:3052–3.

    Article  PubMed  Google Scholar 

  41. Wittstein IS, Thiemann DR, Lima JA, et al. Neurohumoral features of myocardial stunning due to sudden emotional stress. N Engl J Med. 2005;352:539–48.

    Article  PubMed  CAS  Google Scholar 

  42. Ueyama T, Kasamatsu K, Hano T, et al. Catecholamines and estrogen are involved in the pathogenesis of emotional stress-induced acute heart attack. Ann N Y Acad Sci. 2008;1148:479–85.

    Article  PubMed  CAS  Google Scholar 

Download references

Disclosure

No potential conflict of interest relevant to this article was reported.

Author information

Authors and Affiliations

  1. Asan Heart Institute Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-gil Songpa-gu, Seoul, 138-736, South Korea

    Jae-Kwan Song

Authors
  1. Jae-Kwan Song
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jae-Kwan Song.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Song, JK. Stress-Induced Cardiomyopathy. Curr Cardiovasc Imaging Rep 4, 406–415 (2011). https://doi.org/10.1007/s12410-011-9096-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12410-011-9096-2

Keywords

Search

Navigation