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Tako-tsubo cardiomyopathy (apical ballooning)
  1. Holger M Nef,
  2. Helge Möllmann,
  3. Albrecht Elsässer
  1. Kerckhoff Heart Center, Department of Cardiology, Bad Nauheim, Germany
  1. Prof.Dr. med. Albrecht Elsässer, Kerckhoff Heart Center, Department of Cardiology, Benekestr. 2–8, D-61231 Bad Nauheim, Germany; albrecht.elsaesser{at}

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In recent years, a new cardiac syndrome with transient left ventricular dysfunction has been described in Japanese patients. This new entity has been referred to as “tako-tsubo cardiomyopathy” or “apical ballooning”, named for the particular shape of the end-systolic left ventricle in ventriculography.1 To date, tako-tsubo cardiomyopathy has also been reported to occur in the western population. The following clinical characteristics of this phenomenon must be met: (1) transient akinesis or dyskinesis of left ventricular wall motion abnormalities (ballooning) with chest pain; (2) new electrocardiographic changes (either ST elevation or T wave inversion); (3) no significant obstructive epicardial coronary artery disease; (4) absence of recent significant head trauma, intracardial bleeding, phaeochromocytoma, myocarditis, and hypertrophic cardiomyopathy.2

Emotional or physical stress usually precedes this cardiomyopathy. A unifying mechanistic explanation responsible for this acute but rapidly reversible contractile dysfunction is still lacking. Multivessel epicardial coronary artery vasospasm, coronary microvascular dysfunction or spasm, impaired fatty acid metabolism, transient obstruction of the left ventricular outflow, and catecholamine-mediated myocardial dysfunction have been proposed as potential mechanisms.36 The optimal treatment of patients presenting with this syndrome depends primarily on the haemodynamic conditions and remains rather symptomatic in nature.

This article primarily addresses the clinical setting of tako-tsubo cardiomyopathy and describes a broad spectrum of diagnostic tools. Moreover, currently proposed pathophysiological mechanisms are discussed in detail, providing more insight into this new cardiac entity.


Tako-tsubo cardiomyopathy is characterised by acute onset of chest pain and a completely reversible regional contractile dysfunction. In left ventriculography typical wall motion abnormalities, such as apical and mid-ventricular akinesia and a hypercontractile basis, can be documented. Coronary angiography reveals no relevant epicardial coronary artery disease (fig 1). Recently, several cases of transient ballooning involving the mid-ventricular part, sparing the apical and basal segments, have also been documented.7 …

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  • In compliance with EBAC/EACCME guidelines, all authors participating in Education in Heart have disclosed potential conflicts of interest that might cause a bias in the article. All authors declare that the answer to the questions on your competing interest form are all “No” and therefore have nothing to declare