Takotsubo Cardiomyopathy

Prepared and reviewed by the PrepElephant Academic Review Team

First published 14 Oct 2026 · Spot an error?

Reference basis: Harrison's Principles of Internal Medicine; Braunwald's Heart Disease; Davidson's Principles and Practice of Medicine

On this page

Direct answer
What you must remember
Separating takotsubo from anterior STEMI at the bedside
Where the exam tries to catch you
Frequently asked questions
Related topics

Direct answer

Takotsubo cardiomyopathy is a transient, stress-induced left ventricular dysfunction, typically apical ballooning with basal hyperkinesis, that mimics STEMI in patients with normal or non-obstructive coronary arteries. It is triggered by a surge of catecholamines from emotional or physical stress and occurs most often in postmenopausal women. Diagnosis rests on angiographic exclusion of obstructive disease together with the characteristic ventricular pattern, and wall motion usually recovers within weeks with supportive care.

What you must remember

Ventricular pattern: apical and mid-ventricular akinesis with basal hyperkinesis, which does not follow a single coronary territory.
Coronaries: normal or non-obstructive on angiography, which separates it from acute plaque rupture.
ECG: ST elevation and T wave inversion that mimic anterior STEMI, and QT prolongation can occur.
Troponin: raised but often modest, so a small troponin rise does not rule out the diagnosis.
Triggers: emotional stress, bereavement, physical illness and catecholamine surges, including from phaeochromocytoma or sympathomimetic drugs.
Complications: LV outflow tract obstruction, cardiogenic shock, arrhythmia and LV thrombus.
Management: supportive heart failure care with beta-blockers and ACE inhibitors, anticoagulation for LV thrombus, and caution with inotropes.
Prognosis: most patients recover LV function, although recurrence and complications remain possible.

Separating takotsubo from anterior STEMI at the bedside

A 68-year-old woman presents with chest pain and breathlessness a day after her husband's sudden death. Her ECG shows ST elevation in the anterior leads and her troponin is raised, but the coronary angiogram is clear.

Feature	Takotsubo	Anterior STEMI
Coronary angiography	Normal or non-obstructive	Culprit occlusion
Wall motion	Apical ballooning, basal hyperkinesis	Regional, one coronary territory
Typical patient	Postmenopausal woman after stress	Usually with vascular risk factors
Troponin	Raised, often modest	Raised, often high
Recovery	Usually within weeks	Scarring may persist

Takotsubo and anterior STEMI can share ST elevation, so the coronary angiogram is the decisive test. Once obstructive disease is excluded, the ventricular pattern and the emotional trigger confirm the diagnosis.

Catecholamines are thought to stun the myocardium, possibly through direct myocyte injury and microvascular dysfunction. Repeat echocardiography after the acute phase shows whether the wall motion has normalised, which supports the diagnosis and guides prognosis. Most patients recover within weeks, and the diagnosis is revisited if the picture does not fit that course.

Where the exam tries to catch you

Takotsubo questions test the differential from STEMI and the complications.

Trap: Labelling any apical ballooning as takotsubo without angiography. Correct: Normal or non-obstructive coronaries must be confirmed before the diagnosis is accepted.
Trap: Giving inotropes freely for cardiogenic shock. Correct: Inotropes may worsen LV outflow tract obstruction, so the choice of drug needs care.
Trap: Assuming takotsubo is benign. Correct: LV thrombus, arrhythmia, shock and recurrence can all occur.
Trap: Dismissing takotsubo in men. Correct: Men are affected, though far less often than postmenopausal women.

Frequently asked questions

Which coronary finding helps distinguish takotsubo from STEMI?

Normal or non-obstructive coronary arteries on angiography help distinguish takotsubo cardiomyopathy from STEMI, because STEMI requires an acute culprit occlusion. The ventricular pattern and the emotional or physical trigger support the diagnosis once obstruction is excluded.

What is the typical ventricular pattern in takotsubo cardiomyopathy?

Takotsubo cardiomyopathy typically shows apical and mid-ventricular akinesis with basal hyperkinesis, which gives the ventricle the shape of a Japanese octopus pot. This pattern does not follow a single coronary territory, which is a key clue on ventriculography.

Why is LV outflow tract obstruction a concern in takotsubo cardiomyopathy?

Basal hyperkinesis can cause dynamic LV outflow tract obstruction, which worsens hypotension and can precipitate shock. Inotropes such as dobutamine may aggravate this obstruction, so the drug choice is made carefully.

Which triggers are classically linked to takotsubo cardiomyopathy?

Emotional stress such as bereavement, physical illness and catecholamine excess are classic triggers of takotsubo cardiomyopathy. Phaeochromocytoma and sympathomimetic drugs can cause the same catecholamine surge.