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.