Stress-induced cardiomyopathy alternately called Takotsubo cardiomyopathy (TTC), ampulla cardiomyopathy or the transient left ventricular apical ballooning syndrome was described by Sato et al. in 1990 in Japanese population. TTC is characterized by transient, reversible, regional systolic dysfunction involving the left ventricular apex and mid-ventricle with hyperkinesis of the basal left ventricular segments in the absence of obstructive epicardial coronary artery disease. ST-segment elevation in ECG and cardiac enzyme level above upper limit concomitant with angina symptoms mimic ST-segment myocardial infarction (STEMI).

According to the clinical features of TTC, it usually affects elderly (age >60 years), postmenopausal women and is preceded by psychiatric and physical stress. Characteristics of TTC contain a strong female predominance, ST-segment elevation (Fig. 1) or T wave inversion in ECG (Fig. 2), modest biomarkers release and almost complete rapid wall-motion resolution.

During the last decades, reports have shown diverse TTC types. Besides typical TTC, several atypical TTCs like inverse TTC exist. Pathophysiology of TTC has not been well documented so far and may involve coronary vascular dysfunction, abnormal coronary microcirculation, excessive sympathetic stimulation (intracranial bleeding, pheochromocytoma as catecholamine-mediated cardiac toxicity), neurogenic stunning, left ventricular outflow obstruction. The exact mechanism of the entity of TTC is still unclear. The diagnosis of TTC, a rare but not unique condition among patients with acute coronary syndrome (ACS), is currently based on coronary angiography and echocardiography.

Fig. 2

Fig. 1