Takotsubo disease.

Tako-tsubo cardiomyopathy, a novel heart syndrome with peculiar variant of left ventricular dysfunction, characterized by preferential apical dyskinesis and basal hyper contractility has been described on numerous occasions especially in persons without obstructive coronary artery disease. It is considered of reversible etiology and seems to have increased predisposition in elderly, stress-ridden females. Although Tako-tsubo cardiomyopathy was described initially in patients of Japanese origin, its existence in white populations in both Europe and the US have recently been documented. Simultaneous multivessel coronary spasm of the epicardial coronary microvessels is believed to be a major contributor. However, this pathophysiologic basis for this phenomenon has not been validated universally throughout literature. Another potential mechanism of events that seems to be responsible for this phenomenon is the transient myocardial stunning associated with hypersensitivity to catecholamine. The clinical presentation usually simulates that of an acute ST- elevated myocardial infarction but the coronary angiography by definition shows no critical lesions. Patients surviving acute episode usually recover fully in few weeks. Acute onset of cardiogenic shock in a person without coronary risk factors should raise the possibility of this rare type of entity but should not withhold the acute treatment. Prognosis generally varies and has largely been good. Takotsubo though largely benign may be fatal sometimes.