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Open Access Highly Accessed Research article

Multidisciplinary assessment of tako tsubo cardiomyopathy: a prospective case study

Micael Waldenborg2, Mona Soholat3, Anders Kähäri4, Kent Emilsson2 and Ole Fröbert1*

Author Affiliations

1 Department of Cardiology, Örebro University Hospital, Örebro, Sweden

2 Department of Clinical Physiology, Örebro University Hospital, Örebro, Sweden

3 Department of Psychiatry, Örebro University Hospital, Örebro, Sweden

4 Department of Radiology, Orebro University Hospital, Orebro, Sweden

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BMC Cardiovascular Disorders 2011, 11:14  doi:10.1186/1471-2261-11-14

Published: 9 April 2011

Abstract

Background

The cause of tako tsubo cardiomyopathy remains unclear. We used a multidisciplinary approach to investigate if a common pathophysiological denominator could be outlined.

Methods

Within 3 days following symptom presentation and again after 3 months we investigated all patients coming to our institution and diagnosed with tako-tsubo cardiomyopathy. Patients underwent extensive biochemical screening. Left ventricular function was evaluated by echocardiography and contrast-enhanced cardiac magnetic resonance imaging. Cardiac autonomic function was studied by heart rate variability and signal-averaged electrocardiogram and posttraumatic stress and depression were investigated by questionnaires (the Posttraumatic Stress Syndrome 10-Questions Inventory, PTSS-10 and the Montgomery-Åsberg depression rating scale, self rated version, MADRS-S).

Results

During 2 years, 13 consecutive patients were included. Markers of myocardial damage and heart failure were slightly to moderately elevated and ejection fraction (echocardiography and MRi) was moderately reduced at hospitalization and improved to normal values in all patients. Signal averaged ECG demonstrated a statistically significant shorter duration of the filtered QRS complex in the acute phase as compared to follow-up. In heart rate variability analysis, SDNN and SDANN were shorter acutely compared to follow-up. Two patients fulfilled criteria for posttraumatic stress syndrome while 7 patients were in the borderline zone. There was a statistically significant inverse correlation between PTSS-10 score and QRS duration in the signal-averaged ECG (r = -0.66, P = 0.01).

Conclusions

Patients with tako tsubo cardiomyopathy have altered cardiac autonomic function and a high incidence rate of borderline or definite posttraumatic stress syndrome acutely. This is in line with findings in patients with myocardial infarction and does not allow conclusions on cause and effect.