What is the mechanism of Apical Ballooning in Takotsubo cardiomyopathy ?

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What is the mechanism of Apical Ballooning in Takotsubo cardiomyopathy ?

August 31, 2013 by dr s venkatesan

Takotsubo cardiomyopathy is an unusual response of the left ventricle to extreme emotional stress .The catecholamine surge has a profound stunning effect of LV apex and a paradoxical hypercontractility of basal LV.

The exact mechanism is not clear , Following factors may contribute.

Multi-vessel coronary artery spasm,
Cardiac microvascular dysfunction.
Abnormal myocardial fatty acid metabolism,
Reperfusion injury after an ACS *

However , the most accepted mechanism is Endogenous catecholamine-induced myocardial stunning and microinfarction

Why is LV apex alone affected ?

Image Source- http://www.radiologyassistant.nl

The adrenergic receptor distribution is high in LV apex .They are exposed to high concentration and gets stunned easily . Basal LV has less adrenergic innervation , so it shows less of catecholamine toxicity , instead it exhibits. hyper-contractile mode. However, this rule is not absolute.

One more suggestion was apical balloons correlated with wrap around LAD.(Báñez B et all 2004)

what is the mechanism of apical ballooning syndrome 2 takotsubo cardiomyopathy

Image courtesy Circulation December 16/23, 2008 vol. 118 no. 25 2754-2762

*Some consider ACS should never be linked to Takotsubo.But it is not easy to differentiate.(Carrillo JACC 2009) (Kosuge JACC 2010)

Reference from this site

https://drsvenkatesan.wordpress.com/2012/05/27/in-extreme-mental-stress-left-ventricle-becomes-a-banana/

Reference from other journals

what is the mechanism of apical ballooning syndrome takotsubo cardiomyopathy

1.Báñez B, Navarro F, Farré J et al. (2004). Tako-tsubo syndrome associated with a long course of the left anterior descending coronary artery along the apical diaphragmatic surface of the left ventricle.]”. Revista española de cardiología (in Spanish; Castilian) 57 (3): 209–16

2.Carrillo A, Fiol M, Garcia-Niebla J, Bayes de Luna A. Electrocardiographic differential diagnosis between Takotsubo syndrome and distal occlusion of LAD is not easy. J Am Coll Cardiol. Nov 2 2010;56(19

3.Dorfman TA, Iskandrian AE. Takotsubo cardiomyopathy: State-of-the-art review. J Nucl Cardiol. Jan-Feb 2009;16(1):122-34

4.Kosuge M, Ebina T, Hibi K, Morita S, Okuda J, Iwahashi N. Simple and accurate electrocardiographic criteria to differentiate takotsubo cardiomyopathy from anterior acute myocardial infarction. J Am Coll Cardiol. 2010;55(22):2514–6. doi: 10.1016/j.jacc.2009.12.059.