Skip to main content
Log in

Takotsubo cardiomyopathy associated with rupture of the left ventricular apex: assessment of histopathological features of a fatal case and literature review

  • Case Report
  • Published:
Forensic Science, Medicine, and Pathology Aims and scope Submit manuscript

Abstract

Takotsubo cardiomyopathy, also known as “broken heart syndrome,” is a cardiac entity characterized by transient left ventricular dysfunction without obstructive atherosclerotic coronary artery disease. An episode of emotional stress is believed to act as a trigger in the development of this syndrome, which typically occurs in female patients. We report a fatal case of a previously healthy 70-year-old woman who suffered an out-of-hospital cardiac arrest and cardiac rupture during emotional distress, due to Takotsubo cardiomyopathy. Ventricular rupture with Takotsubo cardiomyopathy is rare, but our case emphasizes the importance of dealing with this serious and potentially life-threatening disease. Takotsubo cardiomyopathy should be considered as a differential diagnosis in cases of early-developing heart failure, and clinicians should subsequently use adequate diagnostic and therapeutic options.

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

Access this article

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

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

References

  1. Sharkey SW, Lesser JR, Maron MS, Maron BJ. Why not just call it tako-tsubo cardiomyopathy: a discussion of nomenclature. J Am CollCardiol. 2011;57:1496–7.

    Article  Google Scholar 

  2. Maron BJ, Towbin JA, Thiene G, Antzelevitch C, Corrado D, Arnett D, 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 

  3. Eshtehardi P, Koestner SC, Adorjan P, Windecker S, Meier B, Hess OM, et al. Transient apical ballooning syndrome-clinical characteristics, ballooning pattern, and longterm follow-up in a Swiss population. Int J Cardiol. 2009;135:370–5.

    Article  PubMed  Google Scholar 

  4. Wedekind H, Möller K, Scholz KH. Tako-tsubo cardiomyopathy (Incidence in patients with acute coronary syndrome). Herz. 2006;31:339–46.

    Article  PubMed  Google Scholar 

  5. Akashi YJ, Nakazawa K, Kida K, et al. Reversible ventricular dysfunction (takotsubo cardiomyopathy) following polymorphic ventricular tachycardia. Can J Cardiol. 2003;19:449–51.

    PubMed  Google Scholar 

  6. Bybee KA, Kara T, Prasad A, Lerman A, Barsness GW, Wright RS, et al. Systematic review: transient left ventricular apical ballooning: a syndrome that mimics ST-segment elevation myocardial infarction. Ann Intern Med. 2004;141:858–65.

    Article  PubMed  Google Scholar 

  7. Prasad A, Lerman A, Rihal CS. Apical ballooning syndrome (Tako-Tsubo or stress cardiomyopathy): a mimic of acute myocardial infarction. Am Heart J. 2008;155:408–17.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  9. Eitel I, von Knobelsdorff-Brenkenhoff F, Bernhardt P, Carbone I, Muellerleile K, Aldrovandi A, et al. Clinical characteristics and cardiovascular magnetic resonance findings in stress (Takotsubo) cardiomyopathy. JAMA. 2011;306:277–86.

    CAS  PubMed  Google Scholar 

  10. Pilgrim TM, Wyss TR. Takotsubo cardiomyopathy or transient left ventricular apical ballooning syndrome: a systematic review. Int J Cardiol. 2008;124:283–92.

    Article  PubMed  Google Scholar 

  11. Kumar S, Kaushik S, Nautiyal A, et al. Cardiac rupture in takotsubo cardiomyopathy: a systematic review. ClinCardiol. 2011;34:672–6.

    Google Scholar 

  12. Liang JJ, Cha YM, Oh JK, Prasad A. Sudden cardiac death: an increasingly recognized presentation of apical ballooning syndrome (Takotsubo cardiomyopathy). Heart Lung. 2013;42:270–2.

    Article  PubMed  Google Scholar 

  13. Lyon AR, Rees PS, Prasad S, Poole-Wilson PA, Harding SE. Stress (Takotsubo) cardiomyopathy-a novel pathophysiological hypothesis to explain catecholamine-induced acute myocardial stunning. Nat Clin Pract Cardiovasc Med. 2008;5:22–9.

    Article  CAS  PubMed  Google Scholar 

  14. Wittstein IS, Thiemann DR, Lima JA, Baughman KL, Schulman SP, Gerstenblith G, et al. Neurohumoral features of myocardial stunning due to sudden emotional stress. N Engl J Med. 2005;352:539–48.

    Article  CAS  PubMed  Google Scholar 

  15. Abraham J, Mudd JO, Kapur NK, Klein K, Champion HC, Wittstein IS. Stress cardiomyopathy after intravenous administration of catecholamines and beta-receptor agonists. J Am Coll Cardiol. 2009;53:1320–5.

    Article  CAS  PubMed  Google Scholar 

  16. Akashi YJ, Nef HM, Lyon AR. Epidemiology and pathophysiology of Takotsubo syndrome. Nat Rev Cardiol. 2015;12:387–97.

    Article  PubMed  Google Scholar 

  17. Nef HM, Möllmann H, Kostin S, Troidl C, Voss S, Weber M, et al. Tako- Tsubo cardiomyopathy: intraindividual structural analysis in the acute phase and after functional recovery. Eur Heart J. 2007;28:2456–64.

    Article  PubMed  Google Scholar 

  18. Khullar M, Datta BN, Wahi PL, Chakravarti RN. Catecholamine-induced experimental cardiomyopathy—a histopathological, histochemical and ultrastructural study. Indian Heart J. 1989;41:307–13.

    CAS  PubMed  Google Scholar 

  19. Morel O, Sauer F, Imperiale A, Cimarelli S, Blondet C, Jesel L, et al. Importance of inflammation and neurohumoral activation in Takotsubo cardiomyopathy. J Card Fail. 2009;15:206–13.

    Article  CAS  PubMed  Google Scholar 

  20. Eitel I, Lücke C, Grothoff M, Sareban M, Schuler G, Thiele H, et al. Inflammation in takotsubo cardiomyopathy: from cardiovascular magnetic resonance imaging. Eur Radiol. 2010;20:422–31.

    Article  PubMed  Google Scholar 

  21. Syed FF, Asirvatham SJ, Francis J. Arrhythmia occurrence with Takotsubo cardiomyopathy: a literature review. Europace. 2011;13:780–8.

    Article  PubMed  Google Scholar 

  22. Reich P. Psychological predisposition to life-threatening arrhythmias. Annu Rev Med. 1985;36:397–405.

    Article  CAS  PubMed  Google Scholar 

  23. Akashi YJ, Sakakibara M, Miyake F. Reversible left ventricular dysfunction “takotsubo” cardiomyopathy associated with pneumothorax. Heart. 2002;87:E1.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  24. Akashi YJ, Nakazawa K, Sakakibara M, Miyake F, Sasaka K. Reversible left ventricular dysfunction “takotsubo” cardiomyopathy related to catecholamine cardiotoxicity. J Electrocardiol. 2002;35:351–6.

    Article  PubMed  Google Scholar 

  25. Abe Y, Kondo M, Matsuoka R, Araki M, Dohyama K, Tanio H. Assessment of clinical features in transient left ventricular apical ballooning. J Am Coll Cardiol. 2003;41:737–42.

    Article  PubMed  Google Scholar 

  26. Akashi YJ, Nakazawa K, Sakakibara M, Miyake F, Koike J, Sasaka K. The clinical features of takotsubo cardiomyopathy. QJM. 2003;96:563–73.

    Article  CAS  PubMed  Google Scholar 

  27. Kuo BT, Choubey R, Novaro GM. Reduced estrogen in menopause may predispose women to takotsubo cardiomyopathy. Gend Med. 2010;7:71–7.

    Article  PubMed  Google Scholar 

  28. Ueyama T, Hano T, Kasamatsu K, Yamamoto K, Tsuruo Y, Nishio I. Estrogen attenuates the emotional stress-induced cardiac responses in the animal model of Tako-tsubo (Ampulla) cardiomyopathy. J Cardiovasc Pharmacol. 2003;42(Suppl 1):S117–9.

    Article  CAS  PubMed  Google Scholar 

  29. Elesber AA, Prasad A, Lennon RJ, Wright RS, Lerman A, Rihal CS. Four-year recurrence rate and prognosis of the apical ballooning syndrome. J Am Coll Cardiol. 2007;50:448–52.

    Article  PubMed  Google Scholar 

  30. Sharkey SW, Windenburg DC, Lesser JR, Maron MS, Hauser RG, Lesser JN, et al. Natural history and expansive clinical profile of stress (tako-tsubo) cardiomyopathy. J Am Coll Cardiol. 2010;55:333–41.

    Article  PubMed  Google Scholar 

  31. Elsokkari I, Cala A, Khan S, Hill A. Takotsubo cardiomyopathy: not always innocent or predictable. A unique post mortem insight. Int J Cardiol. 2013;167(2):e46–e48.

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Francesca Indorato.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Indorato, F., Akashi, Y.J., Rossitto, C. et al. Takotsubo cardiomyopathy associated with rupture of the left ventricular apex: assessment of histopathological features of a fatal case and literature review. Forensic Sci Med Pathol 11, 577–583 (2015). https://doi.org/10.1007/s12024-015-9711-7

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12024-015-9711-7

Keywords

Navigation