Inverted Takotsubo cardiomyopathy

Inverted Takotsubo cardiomyopathy


“Inverted Takotsubo” cardiomyopathy (ITC) is a variant of Takotsubo cardiomyopathy in which there is hyperkinesis of apex with mid ventricular ballooning, unlike the reverse pattern seen in classical Takotsubo cardiomyopathy. Instead of the precordial ST segment elevation, inferior ST segment elevation has been reported in these cases. The presentation and clinical features of  ITC are similar to those of typical Takotsubo cardiomyopathy. The difference in pattern of involvement has been attributed to the variation in sympathetic and parasympathetic innervation of the heart. A pattern similar to this has also been reported in subarachnoid hemorrhage. A guideline published from Japan in 2007 mentions that “Inverted Takotsubo” cardiomyopathy should not be included in the diagnosis of Takotsubo cardiomyopathy. Takotsubo cardiomyopathy is also known as ampulla cardiomyopathy, stress cardiomyopathy and broken heart syndrome. Another mid ventricular type of Takotsubo cardiomyopathy has also been described [1].

Basal LV ballooning in inverted Takotsubo cardiomyopathy
Basal LV ballooning in inverted Takotsubo cardiomyopathy

Radhakrishnan Ramaraj and Mohammad Reza Movahed collected the data of 60 cases from literature and found that classic type constituted 67%, inverted type 23% and mid cavitary type 10% [2]. They noted that patients presenting with ITC were significantly younger with mean age of 36 years compared to a mean age of 62 years for other types (P<0.001).

References

  1. Suvro Banerjee. Indian Heart J. 2016 Apr;68 Suppl 1(Suppl 1):S8-9.
  2. Radhakrishnan Ramaraj, Mohammad Reza Movahed. Congest Heart Fail. Nov-Dec 2010;16(6):284-6.