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Takotsubo Cardiomyopathy

  • Joseph Shulan and Allison Rossetti
Published/Copyright: April 1, 2014
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Journal of Osteopathic Medicine
From the journal Journal of Osteopathic Medicine Volume 114 Issue 4

A 77-year-old woman sought immediate medical care for acute onset of severe substernal chest pain. Medical history revealed essential hypertension, hyperlipidemia, diabetes mellitus, and severe depression, for which she was taking fluoxetine, 20 mg/d. Electrocardiogram demonstrated T-wave inversions in leads V and VI, and the patient's troponin I level was elevated (1.65 ng/mL). Coronary angiogram showed minor luminal irregularities in the left anterior descending artery. Left ventriculogram (image) exhibited an ejection fraction of 40% with left ventricle apical akinesis (short arrow) and basal hyperkinesia at the base of the heart (long arrows) creating the appearance of apical ballooning suggestive of takotsubo cardiomyopathy. (Watch the supplemental video at http://www.jaoa.org/content/114/4/321/suppl/DC1.) Plasma normetanephrine and metanephrine levels were normal. Metoprolol succinate, 12.5 mg/d, and aspirin, 81 mg/d, were prescribed, and the patient was discharged to home.

Takotsubo, or stress, cardiomyopathy is a well-described reversible cardiomyopathy typically occurring in postmenopausal women that can mimic an acute coronary event. Although there is no consensus on pharmacologic therapy,1 prevention of left ventricular remodeling, optimization of blood pressure, and management of psychiatric illnesses are recommended.2 Prognosis is favorable.1

From The Ohio State University Wexner Medical Center in Columbus, where Dr Shulan is a third-year internal medicine resident
Address correspondence to Joseph Shulan, DO, 395 W 12th Ave, Room 346D, Columbus, OH 43210-1267. E-mail:

  1. Financial Disclosures: None reported.

References

1 Milinis K Fisher M . Takotsubo cardiomyopathy: pathophysiology and treatment [review][published online May 30, 2012]. Postgrad Med J.2012;88(1043):530-538. doi:10.1136/postgradmedj-2012-130761.10.1136/postgradmedj-2012-130761Search in Google Scholar PubMed

2 Citro R Rigo F Previtali M et al. . Differences in clinical features and in-hospital outcomes of older adults with takotsubo cardiomyopathy[published online October 31, 2011]. J Am Geriatr Soc.2012;60(1):93-98. doi:10.1111/j.1532-5415.2011.03730.x.10.1111/j.1532-5415.2011.03730.xSearch in Google Scholar PubMed

Received: 2013-05-25
Revised: 2013-12-03
Accepted: 2013-12-10
Published Online: 2014-04-01
Published in Print: 2014-04-01

© 2014 The American Osteopathic Association

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Articles in the same Issue

  1. Editorial
  2. Reevaluating Osteopathic Medical Education for the 21st Century and Beyond
  3. Special Report
  4. A Single Graduate Medical Education Accreditation System: Ensuring Quality Training for Physicians and Improved Health Care for the Public
  5. Letters
  6. Unified Graduate Medical Education Accreditation: A Better Plow
  7. Moving From EBM to EBOM: An Osteopathic Perspective on Evidence-Based Medicine
  8. Correction
  9. Correction
  10. Medical Education
  11. Preliminary Outcomes of the Lake Erie College of Osteopathic Medicine's 3-Year Primary Care Scholar Pathway in Osteopathic Predoctoral Education
  12. Student- and Faculty-Reported Importance of Science Prerequisites for Osteopathic Medical School: A Survey-Based Study
  13. Consistency of Interrater Scoring of Student Performances of Osteopathic Manipulative Treatment on COMLEX-USA Level 2-PE
  14. Relationship Between COMLEX-USA Scores and Performance on the American Osteopathic Board of Emergency Medicine Part I Certifying Examination
  15. Concurrent Validity of the Osteopathic General Surgery In-Service Examination
  16. Keyboard Data Entry Use Among Osteopathic Medical Students and Residents
  17. Colleges of Osteopathic Medicine: Substantive Changes—An Update
  18. Citation and Correction of Deficiencies in Osteopathic Graduate Medical Education Programs: Opportunities for Improvement
  19. AOA Continuing Medical Education
  20. Appendix
  21. Appendix 1: Osteopathic Graduate Medical Education 2014
  22. Appendix 2: Dual and Parallel Postdoctoral Training Programs
  23. Appendix 3: AOA Specialty Board Certification
  24. Appendix 4: Colleges of Osteopathic Medicine
  25. Clinical Images
  26. Takotsubo Cardiomyopathy
  27. Postpartum Internal Hernia
https://doi.org/10.7556/jaoa.2014.061
Creative Commons
BY-NC-ND 4.0

Articles in the same Issue

  1. Editorial
  2. Reevaluating Osteopathic Medical Education for the 21st Century and Beyond
  3. Special Report
  4. A Single Graduate Medical Education Accreditation System: Ensuring Quality Training for Physicians and Improved Health Care for the Public
  5. Letters
  6. Unified Graduate Medical Education Accreditation: A Better Plow
  7. Moving From EBM to EBOM: An Osteopathic Perspective on Evidence-Based Medicine
  8. Correction
  9. Correction
  10. Medical Education
  11. Preliminary Outcomes of the Lake Erie College of Osteopathic Medicine's 3-Year Primary Care Scholar Pathway in Osteopathic Predoctoral Education
  12. Student- and Faculty-Reported Importance of Science Prerequisites for Osteopathic Medical School: A Survey-Based Study
  13. Consistency of Interrater Scoring of Student Performances of Osteopathic Manipulative Treatment on COMLEX-USA Level 2-PE
  14. Relationship Between COMLEX-USA Scores and Performance on the American Osteopathic Board of Emergency Medicine Part I Certifying Examination
  15. Concurrent Validity of the Osteopathic General Surgery In-Service Examination
  16. Keyboard Data Entry Use Among Osteopathic Medical Students and Residents
  17. Colleges of Osteopathic Medicine: Substantive Changes—An Update
  18. Citation and Correction of Deficiencies in Osteopathic Graduate Medical Education Programs: Opportunities for Improvement
  19. AOA Continuing Medical Education
  20. Appendix
  21. Appendix 1: Osteopathic Graduate Medical Education 2014
  22. Appendix 2: Dual and Parallel Postdoctoral Training Programs
  23. Appendix 3: AOA Specialty Board Certification
  24. Appendix 4: Colleges of Osteopathic Medicine
  25. Clinical Images
  26. Takotsubo Cardiomyopathy
  27. Postpartum Internal Hernia
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