Recurrent takotsubo cardiomyopathy

Variable pattern of ventricular involvement

Rezidivierende Takotsubo-Kardiomyopathie

Variables Muster der Ventrikelbeteiligung



Takotsubo cardiomyopathy (TTC) is a transient left ventricular (LV) dysfunction that predominantly affects older women and has three main variants: apical, mid-ventricular, and basal. The recurrence rate of TTC is roughly around 11 % at 4-year follow-up. The pathogenesis of TTC is not clear and various theories have been proposed without concrete evidence.

Case series

We present a case series of 3 patients with recurrent TTC involving a different region of the ventricle during recurrence. All the patients presented with acute coronary syndrome (ACS) during the initial and recurrent episode. At the initial presentation, all the patients underwent selective coronary angiography (CA), transthoracic echocardiography (TTE), and cardiac magnetic resonance imaging (CMR) evaluation. However, the recurrent episodes were diagnosed without the need of CA, except in 1 patient who presented with ST-segment elevation myocardial infarction.


Recurrence of TTC is common and can be diagnosed without CA in some cases. During recurrence, the regional involvement of the left ventricle can vary in the same person. Variable regional involvement in the same patient rules out some of the proposed theories on the pathogenesis such as: beta-receptor gradient, wrap-around left anterior descending, and coronary artery spasm.



Bei der Takotsubo-Kardiomyopathie (TTC) handelt es sich um eine transiente linksventrikuläre Funktionsstörung, die überwiegend ältere Frauen betrifft und 3 Hauptvarianten aufweist: die apikale, mittventrikuläre und basale Form. Die Rezidivrate der TTC liegt bei einer 4-Jahres-Nachbeobachtung grob um 11 %. Die Pathogenese der TTC ist nicht klar, es bestehen verschiedene Theorien ohne konkrete Belege.


Es wird hier eine Fallserie von 3 Patienten mit rezidivierender TTC und Beteiligung einer anderen Region beim Rezidiv vorgestellt. Bei allen Patienten lag während der Index- und der Rezidivepisode das Bild eines akuten Koronarsyndroms vor. Im Rahmen der Indexerkrankung wurden bei allen Patienten eine selektive Koronarangiographie, eine transthorakale Echokardiographie und eine kardiale MRT-Untersuchung durchgeführt. Die Rezidivepisoden wurden jedoch ohne die Notwendigkeit einer Koronarangiographie außer bei einem Patienten mit ST-Hebungs-Infarkt diagnostiziert.


Ein Rezidiv einer TTC ist häufig und kann in einigen Fällen ohne Koronarangiographie diagnostiziert werden. Während des Rezidivs kann die regionale Beteiligung des linken Ventrikels bei derselben Person variieren. Die Beteiligung variabler Regionen bei demselben Patienten schließt einige der vorgeschlagenen Theorien zur Pathogenese aus, z. B.: ein Betarezeptorgradient, eine Umhüllung um den Ramus interventricularis anterior der A. coronaria sinistra und ein Koronararterienspasmus.

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On behalf of all authors, the corresponding author states that there are no conflicts of interest.

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Correspondence to Dr. K. Singh MD, FRACP.

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Singh, K., Parsaik, A. & Singh, B. Recurrent takotsubo cardiomyopathy. Herz 39, 963–967 (2014) doi:10.1007/s00059-013-3896-x

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  • Takotsubo cardiomyopathy
  • Recurrent
  • Stress cardiomyopathy
  • Ventricular involvement
  • Pathogenesis


  • Takotsubo-Kardiomyopathie
  • Rezidiv
  • Stresskardiomyopathie
  • Ventrikelbeteiligung
  • Pathogenese