Stress Induced Cardiomyopathy in Post-Menopausal Women

Takotsubo cardiomyopathy occurs in post-menopausal women undergoing emotional stress. The symptom of Takotsubo cardiomyopathy is an uncommon etiology of cardiac chest pain. Clinical characteristics include cardiac enzyme elevation, electrocardiogram changes, apical wall motion abnormalities and left ventricular dysfunction. However, cardiac catheterization typically show normal coronary vessels. There were also wall motion abnormalities consistent with Takotsubo pathophysiology as follows: mild LV dilation, LV dyskinesia at the anterior, apical, and distal inferior walls; and a hyper dynamic base. The most effective treatment for TCM is currently unknown due to the lack of case-control trials. However, most commonly antiplatelet medications, angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARB), and beta-adrenergic antagonists are used for treatment. Recurrence is documented, but is an extremely rare finding.

Recurrence occurs primarily in women and more commonly after TCM episodes associated with severe left ventricular dysfunction8. Singh demonstrated that patients with recurrence commonly have a significantly lower LVEF during the first episode of TCM, compared to their counterparts that did not experience recurrence. The most effective treatment for TCM is currently unknown due to the lack of case-control trials. Therefore, TCM is often treated supportively. TCM patients are most commonly discharged on antiplatelet medications, angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARB), and beta-adrenergic antagonists.

       Recurrence of TCM is a rare phenomenon making the incidence difficult to determine. Individual reports of incidence have been highly variable with ranges from 1.5-10%. Systematic reviews estimate recurrence rates of 1.5- 3.5%. Of note, they also found that the cumulative incidence of recurrence increased from 1.2% at the first six months, to nearly 5% at 6 years.

. The above Article originally got published at SciFed Journal of Cardiology in 2017, To have a glance please visit: Click Here