Takotsubo cardiomyopathy associated with rupture of the left ventricular apex: assessment of histopathological features
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CASE REPORT
Takotsubo cardiomyopathy associated with rupture of the left ventricular apex: assessment of histopathological features of a fatal case and literature review Francesca Indorato1 • Yoshihiro J. Akashi2 • Carlo Rossitto3 • Cataldo Raffino3 Giovanni Bartoloni1
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Accepted: 25 August 2015 Ó Springer Science+Business Media New York 2015
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. Keywords Takotsubo cardiomyopathy Ventricular rupture Stress cardiomyopathy Emotional stress
& Francesca Indorato [email protected] 1
Department ‘‘GF Ingrassia’’, Section of Legal Medicine, University of Catania, Via S. Sofia, 87 – Edificio C, 95123 Catania, Italy
2
Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
3
Diagnostic Pathology, Garibaldi Nesima Hospital, Catania, Italy
Introduction Takotsubo cardiomyopathy (TCM), also known as apical ballooning syndrome, ‘‘broken heart syndrome,’’ and stress cardiomyopathy [1], is a mimic of acute coronary syndrome and typically occurs following physical or emotional distress. TCM is a transient wall motion abnormality of the left ventricular (LV) apex accompanied by emotional and/or physical stress that has usually completely recovered. Left ventriculography during systole in patients with TCM exhibits a shape similar to a ‘‘Takotsubo’’—a Japanese word for a narrow-necked, round-bottom pot used to catch octopuses. Although TCM is a relatively new syndrome, the number of reported cases is increasing rapidly. Acute heart failure and cardiogenic shock are the two most frequent complications of TCM; however, ventricular arrhythmias may also occur. In 2006, the American Heart Association included this disease as an acquired cardiomyopathy [2]. In the present report, we describe a rare fatal case of TCM, paying particular attention to the pathological characteristics of one of its complications, ventricular rupture (VR). VR is associated with rapid clinical decline and is uniformly lethal when not surgically repaired. According to previously published retrospective reviews, patients with TCM account for approximately 2 % of all patients with suspect
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