About the book
Stress cardiomyopathy (Takotsubo cardiomyopathy) is a syndrome characterized by left ventricular dysfunction in the absence of coronary artery disease. Underlying pathogenesis includes catecholamine excess, microvascular dysfunction, and multi vessel coronary artery spasm. The diagnosis of stress cardiomyopathy should be suspected in adults who present with a suspected acute coronary syndrome, with symptoms such as chest pain or dyspnea in combination with electrocardiographic changes and/or cardiac troponin elevation, particularly when the clinical manifestations and electrocardiographic abnormalities are out of proportion to the degree of elevation in cardiac biomarkers. Diagnostic criteria include presence of transient regional wall motion abnormalities typically not in a single coronary distribution, absence of angiographic evidence of obstructive coronary disease or acute plaque rupture, presence of new electrocardiographic abnormalities or modest troponin elevation, and absence of pheochromocytoma or myocarditis. Wall motion abnormalities in patients with stress cardiomyopathy are typically detected by echocardiography or left ventriculography. Patterns of left ventricular wall motion abnormality in patients with stress cardiomyopathy include the apical type which occurs in the most cases, and atypical variants including mid-ventricular, basal, focal -limited to an isolated segment, and global types.