Tako-tsubo-like left ventricular dysfunction
It is not very often that a novel cardiac syndrome
provokes such a great interest from cardiologists world-
wide. In 1991, cardiologists from Hiroshima, Japan
were the first to report a cardiac syndrome with female
preponderance exhibiting transient left ventricular
apical ballooning, electrocardiographic changes, and
minimal myocardial enzymatic release mimicking acute
myocardial infarction without significant epicardial
coronary artery disease.
1
The cardiologists from the
Hiroshima City Hospital originally proposed the term
tako-tsubo-like left ventricular dysfunction, because
the typical shape on end-systolic left ventriculogram
resembles a tako-tsubo (octopus trap) with a round
(akinetic) apex and narrow (hyperkinetic) base. Based
on the first series of 30 patients from this group, pub-
lished ten years later, they believed that simultaneous
multivessel coronary spasm was one of the main
causes.
2
Of note, in their series of 30 patients acute
coronary angiography revealed no coronary artery dis-
ease in 25 patients, and only moderate single coronary
artery disease in five patients. Three patients showed
spontaneous multivessel coronary spasm. In ten
patients, coronary spasm could be provoked by either
ergonovine or acetylcholine.
2
Vasospastic ischaemia is
supposed to be more common in Japan than in the
rest of the world.
3