Background
Takotsubo Cardiomyopathy (TC), first described in Japan in 1990, is an
acute cardiac condition that involves transient systolic dysfunction due
to ballooning of the apex and/or mid segments of the left ventricle.
[1] TC is also known as “apical ballooning syndrome”,
“stress-induced cardiomyopathy”, “broken heart syndrome”, and
“ampulla cardiomyopathy”. The name Takotsubo was derived from the
Japanese word for octopus emblematic of the appearance of the left
ventricle on ventriculography during an acute attack. The typical TC
includes apical ballooning during systole due to hypokinesis or akinesis
of the apex or mid ventricle and hyperkinesis of the basal walls.
Atypical variants of TC include hypokinesis of the mid-ventricle alone
[2], hypokinesis of the base, and global hypokinesis. [3]
TC patients are typically postmenopausal Asian or Caucasian women.
Gianni et al reported that 88.8% of 286 reported TC patients were
women. The mean age ranges from 61-76 years. [4] The exact
prevalence of TC is unknown, but researchers have reported that
1.7-2.2% of suspected ACS patients have TC. [5-7]
TC is usually but not always brought on by an acute medical illness or
an intense mental or physical stressor. [8] TC patients typically
present with symptoms similar to ACS, including chest pain with
echocardiographic changes and elevated cardiac markers. However, upon
angiography no significant coronary artery obstruction is appreciated.
Sadamatsu et al reported two cases with apical wall abnormalities and
reduced coronary flow without coronary stenosis. [9]
We report a case of Takotsubo cardiomyopathy in a patient who initially
presented with severe hyponatremia from beer potomania. This patient did
not present with chest pain however, the apical ballooning and negative
coronary artery disease was discovered on left heart catherization and
ventriculogram.