Mid-Ventricular Takotsubo Cardiomyopathy

Takotsubo Cardiomyopathy is a reversible myocardial injury that presents with distinctive regional wall abnormalities of the left ventricle — first identified and discussed in the early 1990s in Japan. This condition, predominantly found in postmenopausal females, usually presents after significant emotional or physical stressors. On presentation, patients have signs and symptoms of typical acute coronary artery syndrome (cardiac enzyme elevation, ischemic electrocardiogram changes, and chest pain) but lack coronary obstruction on angiographic evaluation. Different forms of this cardiomyopathy over time are seen in patients and are widely categorized into two categories. Typical Variant This type of Takotsubo involves the apical ballooning of the left ventricle during systole with likely hyperkinesis of the basal segments. The majority of patients with Takotsubo cardiomyopathy syndrome fall into the typical variant category. Atypical Variants This type of Takotsubo involves the basal, focal, mid-ventricular, biventricular (apical and right ventricle), isolated right ventricular, and global variants.