Original Article Open Access
Copyright ©2013 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Cardiol. Jul 26, 2013; 5(7): 228-241
Published online Jul 26, 2013. doi: 10.4330/wjc.v5.i7.228
Initial clinical presentation of Takotsubo cardiomyopathy with-a focus on electrocardiographic changes: A literature review of cases
Erick Francisco Sanchez-Jimenez
Erick Francisco Sanchez-Jimenez, Emergency Department, Hospital CIMA San Jose, Escazu, 5416-1000 San Jose, Costa Rica
Author contributions: Sanchez-Jimenez EF reviewed all the articles and designed the manuscript.
Correspondence to: Erick Francisco Sanchez-Jimenez, MD, Emergency Department, Hospital CIMA San Jose, Colegio de Medicos y Cirujanos de Costa Rica, Escazu, 5416-1000 San Jose, Costa Rica. erick_fsj@hotmail.com.
Telephone: +506-88-243537 Fax: +506-24-948231
Received: April 4, 2013
Revised: May 12, 2013
Accepted: June 1, 2013
Published online: July 26, 2013

Abstract

AIM: To review the initial presentation and demonstrate the importance of Takotsubo cardiomyopathy.

METHODS: A PubMed search using the terms “Takotsubo cardiomyopathy (TC)” and “apical ballooning syndrome” yielded 211 publications. Only those that were relevant were fully reviewed. The gender, age, precipitating stressor, main complaint at presentation, electrocardiogram (ECG) at admission and serum cardiac markers of patients diagnosed with TC, were extracted as available. The data were organized in tables and graphics, and the incidence of the disorder was calculated and analyzed.

RESULTS: A total of 250 clinical cases were examined. The predominant gender that was affected was female, with a prevalence of 87.5%. The mean age of presentation was 64 ± 14 years. The cases were divided by age into 10-year intervals. The age interval of 60-69 years showed the highest frequency of TC, accounting for 79 cases. The most common precipitating stressor was physical (50% of cases). Chest pain was the primary complaint at presentation (58.8% of cases) followed by dyspnea (30% of cases). The ST segment changes category was the most common (60%), followed by T wave changes (39.6%). Of the 60% of cases with ST segment changes, 12% had concomitant T wave changes. This means that for 27.6% of the cases, the primary abnormality in the ECG was T wave changes; 87.6% of cases with TC had a change in the ST segment, in the T wave or in both. The percentage of ECGs presenting with changes in the anterior wall was 54.4% (35.6% of ST segment elevation + 1.6% of ST segment depression + 17.2% of T wave inversion). The percentage of patients presenting with changes in the lateral segment of the heart was 46.8%, while the percentage of patients with changes in the inferior heart was 21.6% and the percentage of patients with changes in the apical region was only 16%. The prevalence of elevated creatinine kinase and/or troponin on initial presentation was 89.3%.

CONCLUSION: It is essential that every physician consider Takotsubo cardiomyopathy as a possible differential diagnosis when a patient is classified with acute coronary syndrome. To do so, it is necessary to know the clinical presentation of this syndrome in its early stages.

Key Words: Apical ballooning syndrome, Broken heart syndrome, Stress cardiomyopathy, Takotsubo cardiomyopathy, Takotsubo syndrome

Core tip: Takotsubo cardiomyopathy is a syndrome that, while frequently not recognized, has a significant impact and represents a significant percentage of diagnosed acute coronary syndromes. The importance of its recognition by physicians should be stressed. There are no previously published articles that analyze a significant number of reported cases of Takotsubo cardiomyopathy, nor are prior literature reviews available that examine all the points discussed by this author relative to the initial stages of the disease.



INTRODUCTION

Takotsubo cardiomyopathy (TC), apical ballooning syndrome and stress cardiomyopathy have all been used to refer to a syndrome that was described for the first time in 1991 in Japan. Five such cases were shown to have left ventriculograms with transient akinesis in the apical diaphragmatic and/or anterolateral wall but hyperkinesis in the basal wall of the heart[1].

Many hypotheses have been proposed to explain the pathophysiology of TC, including multivessel coronary vasospasm, abnormalities of coronary microvascular function, and catecholamine-mediated cardiotoxicity[2]. Some authors consider estrogen an important factor because it changes the β1:β2 adrenoreceptor (AR) ratio in favor of the β2 AR-Gi protein, which protects the myocardium from catecholamines in stressful situations[3].

The typical initial presentation pattern as chest pain and/or dyspnea, the electrocardiographic changes and elevated serum cardiac markers observed in TC patients often result in the misdiagnosis of TC as acute coronary syndrome (ACS). For the diagnosis of TC, it is necessary to perform echocardiography to observe the wall motion abnormality and coronary angiography to confirm the absence of significant stenotic lesions[2-4]. For some authors, cardiac magnetic resonance imaging (CMRI) (Figure 1) is very important due to its unique ability to assist diagnosis with noninvasive techniques; certainly, CMRI is very helpful in the differential diagnosis of TC and myocarditis, and with patient follow-up[5].

Figure 1
Figure 1 Graphic showing total cases grouped by age intervals.

Many authors mention that the electrocardiographic changes that are seen in the presentation of TC are similar to those of ACS, particularly ST segment elevation myocardial infarction (STEMI); the similarities may include ST segment changes, T wave changes and QT interval changes[6].

This article analyzes the initial clinical presentation of a large number of cases of TC that have been described in the literature and assesses various parameters with a focus on electrocardiographic changes.

MATERIALS AND METHODS

The reviewed articles were found on PubMed using the search terms “Takotsubo cardiomyopathy” and “apical ballooning syndrome”. Three filters, namely “case reports”, “free text available” and “humans”, were used. After setting those filters, 211 articles were found. Of these, only those relevant to TC, which accounted for 197 articles, were fully reviewed. Of these, eight were eliminated because they did not include electrocardiograms or because the final diagnosis was not TC. Therefore, the study was conducted using 189 articles in total.

The criteria used to define TC, were those used by each author in each clinical case. One case of right ventricular Takotsubo[7] and several cases of reverse Takotsubo, broken-heart syndrome and stress cardiomyopathy were also included.

The following data were extracted upon availability: gender, age, precipitating stressor, main complaint at presentation, electrocardiogram (ECG) at admission and serum cardiac markers.

There was no age restriction for inclusion of cases in the study. Cases were classified by age using intervals of 10 years for better management of information. Two patients, a 16-year-old and a 90-year-old, fell outside the first interval of 20-29 years and the last interval of 80-89 years. The median and mean age of the patients and the standard deviations of these values were calculated.

The precipitating stressors were grouped into four categories: physical (physical effort, organic disease or medical condition); emotional (psychological, anxiety or family situation); undetermined (unclear whether the precipitating stressor was emotional, physical or both); no stressor (no identifiable stressor in the history); and not available (not available in the review article). The prevalence of each precipitating stressor was then calculated.

Due to the variable nomenclature assigned by the authors to the main complaint at presentation, it was decided that this nomenclature should be merged into single terms that described all patients who showed similar symptoms. The term “chest pain” was used to include chest discomfort, chest tightness and retrosternal discomfort. “Dyspnea” was used to include respiratory distress, shortness of breath, orthopnea and pulmonary congestion. “Hypotension” included hemodynamic instability, right heart failure and cardiogenic shock. “Loss of consciousness” included ventricular fibrillation and cardiopulmonary arrest, and “palpitations” included tachycardia. After all signs and symptoms were classified, they were listed and their prevalence was calculated based on the total number of cases.

The presence of a minimum of one ECG description was set when choosing the articles. The first ECG was extracted and was preferred for every case. If the time at which the test was taken was not specified, the test made available in the article was assumed to be the first and only test performed and was used in this study. If multiple tests were performed during the initial case presentation, the test that was performed first was extracted. All electrocardiographic descriptions of each case were obtained. The ECG data were grouped into the following categories: ST segment changes, T wave changes, Q wave changes, QT prolonged, normal category and others. If the ECG showed documented long-standing changes such as LBBB (left bundle branch block) or AV block, the cases were not considered in this study. The incidence of each of these categories in the ECG data was calculated (Table 1).

Table 1 Electrocardiographic findings organized by frequency in presentation.
Electrocardiogram descriptionCases (n)Incidence (%)
ST segment changes15060.00
T wave changes9939.60
Prolonged QT2610.40
Normal166.40
Q wave114.40
AV block72.80
LBBB62.40
RBBB62.40
AF52.00
VT31.20
VF31.20
Ventricular bigeminy20.80
Other110.40

The ST segment category was also divided into four groups based on the following specific changes: ST segment elevation, ST segment depression, flattened ST segment and non-specific ST segment changes (Table 2). The incidence of each based on the ST segment changes category and on the total population was calculated.

Table 2 ST segment, T wave change categories organized by incidence.
Cases (n)Categoryincidence1 (%)Global inci-dence2 (%)
ST segment changes
ST segment elevation13590.0054.00
ST segment depression113 (214)7.304.40
ST segment non-specific changes32.001.20
ST segment flattened10.700.40
T wave changes
T wave inversion9191.9036.40
Hyperacute T wave44.001.60
Flattened T wave22.000.80
Non-specific T wave changes22.000.80

The analysis of the T wave changes was also divided into four groups: T wave inversion, hyperacute T wave, flattened T wave and non-specific T wave changes (Table 2), and the incidence of each based on both the T wave category and the total cases was calculated.

The ECG findings were classified by anatomical region of the heart into inferior, lateral, septal, anterior and non-specific, based on the altered leads[8]. The incidence of abnormalities in each region was calculated and further analyzed (Table 3).

Table 3 Incidence of electrocardiographic change categories shown by anatomical region.
Category and LocalizationCases (n)Category inci-dence1 (%)Global inci-dence2 (%)
ST segment elevation
Anterior8965.9035.60
Lateral6648.9026.40
Inferior2619.3010.40
Septal (apical)2417.809.60
Not specified2216.308.80
ST segment depression3
Anterior436.401.60
Lateral654.502.40
Inferior545.502.00
Septal (apical)00.000.00
Not specified218.200.80
T wave changes4
Anterior43 (25)43.4017.20
Lateral45 (15)45.5018.00
Inferior2323.209.20
Septal (apical)1616.206.40
Not specified1515.206.00

The serum cardiac markers creatinine kinase (CK-MB) and/or troponin were classified as normal or elevated; the latter category included mild, moderate and severe elevation. The results extracted were the first test during the admission or the first test result after suspecting a case. The prevalence of each marker elevation was calculated.

RESULTS

One hundred and eighty-nine case report articles, each of which included one or more individual clinical cases, were analyzed; in total, 250 clinical cases were examined (Table 4).

Table 4 Total number of cases analyzed tables.
No.Age (yr)Ref.No.Age (yr)Ref.No.Age (yr)Ref.
130Muller et al[8]8569Haghi et al[70]16968Lisi et al[140]
267Yaoita et al[9]8669Haghi et al[70]17071Rotondi et al[141]
373Izumi et al[10]8743Haghi et al[70]17182Kawano et al[142]
462Kobayashi et al[11]8869Haghi et al[70]17279Hutchings et al[143]
565Ker et al[12]8952Di Valentino et al[71]17355Hutchings et al[143]
678Lau et al[13]9068Stähli et al[72]17482Zuhdi et al[144]
762Hayashi et al[14]9165Vivo et al[73]17545Stout et al[145]
865Peraira Moral et al[15]9281Sacha et al[74]17676Daly et al[146]
981Wedekind et al[16]9353Fiol et al[75]17778Daly et al[146]
1081Davin et al[17]9461Oberson et al[76]17865Saito et al[147]
1179Teo[18]9529Magno et al[77]17975Silberbauer et al[148]
1251Arroyo et al[19]9682Kim et al[78]18047Biteker et al[149]
1379Consales et al[20]9771Kume et al[79]18174Merli et al[150]
1464Maruyama et al[21]9878Kume et al[79]18272Merli et al[150]
1580Nguyen et al[22]9977Kume et al[79]18371Merli et al[150]
1684Nishikawa et al[23]10074Kume et al[79]18475Merli et al[150]
1753Sakihara et al[24]10178Kume et al[79]18557Virani et al[151]
1866Ono et al[25]10278Ahn et al[80]18664Virani et al[151]
1948Daly et al[26]10355Mahida et al[81]18744Virani et al[151]
2076Iengo et al[27]10453Bianchi et al[82]18864Virani et al[151]
2144Pison et al[28]10561Hwang et al[83]18969Chia et al[152]
2252Pison et al[28]10655Ikeda et al[84]19057Yazdan-Ashoori et al[153]
2381Desmet et al[29]10775Ikeda et al[84]19178Shah et al[154]
2478Desmet et al[29]10864Suzuki et al[85]19224Volman et al[155]
2565Desmet et al[29]10988Teraoka et al[86]19368Salemi et al[156]
2671Desmet et al[29]11060Hara et al[87]19450Coutance et al[157]
2748Desmet et al[29]11189Kurisu et al[88]19566Parker et al[158]
2866Desmet et al[29]11277Kurisu et al[88]19681Oe et al[159]
2952Desmet et al[29]11373Verberne et al[89]19768Fazal et al[160]
3048Desmet et al[29]11460Subramanyam et al[90]19846Afonso et al[161]
3145Desmet et al[29]11541Sanchez-Recalde et al[91]19938Afonso et al[161]
3266Desmet et al[29]11641Barriales-Villa et al[92]20052Afonso et al[161]
3357Desmet et al[29]11760Fuse et al[93]20154Sacco et al[162]
3460Desmet et al[29]11880Kawano et al[94]20273Daly et al[163]
3569Desmet et al[29]11963Wong et al[95]20355Jabiri et al[164]
3641Manivannan et al[30]12054Kimura et al[96]20458Madaria Marijuan et al[165]
3760Prasad et al[31]12177Varela et al[97]20550Traullé et al[166]
3865Chandrasegaram et al[32]12255Elkhateeb et al[98]20632D’Amato et al[167]
3984Wang et al[33]12359Kaushik et al[99]20744Artukoglu et al[168]
4073Wani et al[34]12453Uechi et al[100]20885Shah et al[169]
4154Wani et al[34]12567To et al[101]20961Cruvinel et al[170]
4263Wani et al[34]12672To et al[101]21055Lateef[171]
4370Schmidt et al[35]12746Mehta et al[102]21170Potter et al[172]
4446Zaman et al[36]12863Oomura et al[103]21273Agarwal et al[173]
4573Meimoun et al[37]12927Volz et al[104]21372Opolski et al[174]
4622Sasaki et al[38]13079Miyazaki et al[105]21467Y-Hassan et al[175]
4786Surapaneni et al[39]13183Akashi et al[106]21587Kurisu et al[176]
4824Park et al[40]13281Wissner et al[107]21678Kurisu et al[176]
4985Cherian et al[41]13347Papanikolaou et al[108]21770Gotyo et al[177]
5041Lee et al[42]13462Bonnemeier et al[109]21879Singh et al[178]
5130Lee et al[42]13560Haghi et al[110]21944Núñez et al[179]
5289Korlakunta et al[43]13678Rau et al[111]22062Núñez et al[179]
5369Magri et al[44]13753Dahdouh et al[112]22152Núñez et al[179]
5465Rahman et al[45]13869Moriya et al [113]22269Núñez et al[179]
5563Khallafi et al[46]13944Hasdemir et al[114]22369Núñez et al[179]
5675Demirelli et al[47]14053Mariano et al[115]22429Jayaraman et al[180]
5775Latib et al[48]14136Sun et al[116]22571Carxvalho et al[181]
5858Altman et al[49]14275Dandel et al[117]22678Guttormsen et al[182]
5965Bagga et al[50]14365Ionescu et al[118]22753Mrdovic et al[183]
6061Buchholz et al[51]14416Maruyama et al[119]22884Auer et al[184]
6161Zhou et al[52]14570Sato et al[120]22964Auer et al[184]
6274Mittal et al[53]14663Shah et al[121]23064Auer et al[184]
6347Kim et al[54]14762Lee et al[122]23182Auer et al[184]
6460Doesch et al[55]14867Merchant et al[123]23263Arslan et al[185]
6566Lopes et al[56]14986Merchant et al[123]23366Arslan et al[185]
6664Lopes et al[56]15076Merchant et al[123]23470Arslan et al[185]
6776Lopes et al[56]15142Merchant et al[123]23571Arslan et al[185]
6858Lopes et al[56]15276Nault et al[124]23676Barriales Vila et al[186]
6951Lopes et al[56]15362Nault et al[124]23778Barriales et al[186]
7063Sealove et al[57]15471Novo et al[125]23870Barriales et al[186]
7182Inoue et al[58]15568Blázquez et al[126]23974Guardado et al[187]
7225Maréchaux et al[59]15674Ramanath et al[127]24045Cho et al[188]
7377Arias et al[60]15770Biswas et al[128]24168Gallego Page et al[189]
7476Vasconcelos Filho et al[61]15861Preti et al[129]24264Sousa et al[190]
7561Margey et al[62]15959Selke et al[130]24368Jakobson et al[191]
7667Purvis et al[63]16074Alves et al[131]24449Jakobson et al[191]
7759Biłan et al[64]16183Yeh et al[132]24574Otomo et al[192]
7853Lentschener et al[65]16268Kurisu et al[133]24675Otomo et al[192]
7961Kyuma et al[66]16357Rotondi et al[134]24755Gomes et al[193]
8076Kyuma et al[66]16484Guevara et al[135]24861Furushima et al[194]
8176Kyuma et al[66]16569Ukita et al[136]24984Sakai et al[195]
8281Figueredo et al[67]16673van de Donk et al[137]25064Hakeem et al[196]
8360Naganuma et al[68]16766Mawad et al[138]
8461Laínez et al[69]16890Xu et al[139]
Gender

The predominant gender was female; it accounted for 219 cases with a prevalence of 87.5%.

Age

The age of the patients ranged from 16-90 years. The mean age at presentation was 64 ± 14 years, with a 95%CI of 64 ± 2 years and a median of 66 years. Figure 1 shows the number of cases grouped by 10-year intervals with respect to age. The age interval with the highest number of cases is 60-69 years; it includes 79 cases.

Precipitating stressor

Figure 2 shows the distribution of precipitating events among all cases. The 6 (2%) cases listed as “undetermined” were difficult to categorize. For example, a patient who had an operation was very stressed and anxious about the surgery results[9]. In the cases where the stressor was not available, the author did not mention whether there was a precipitating factor.

Figure 2
Figure 2 Graphic showing precipitating stressors grouped in categories for all cases studied.
Main complaint at presentation

Table 5 shows the frequency of presentation of all cases grouped with respect to symptoms and signs. Chest pain and dyspnea together were encountered in only 49 (20%) cases.

Table 5 Frequency of the main complaints reported in the cases studie.
Main complaintPresentation frequency (%)
Chest pain58.80
Dyspnea30.00
Hypotension8.40
Nausea and/or vomiting8.00
Syncope6.40
Palpitations5.20
Asymptomatic4.80
Loss consciousness5.20
Headache3.60
Epigastric pain2.00
Dizziness2.00
Weakness2.00
Cough1.60
Back pain1.60
Pedal edema1.20
Seizure0.80
Othersa0.40
Electrocardiogram at admission

Table 1 shows the incidences of various types of electrocardiographic abnormalities in the TC cases. Of the 60% of cases with ST segment changes, 12% had concomitant T wave changes, indicating that the main abnormality in the ECG for 27.6% of cases was T wave changes and that 87.6% of cases with TC had a change in the ST segment, in the T wave or both. Slow R progression was found in 3 cases, and tachycardia was found in 17 cases; one case of an anterior infarct of indeterminate age[10] was classified into the normal category.

Table 2 shows the incidence of specific ST segment changes. The incidence of ST segment depression in the total population (250 cases) and in the ST segment category (150 cases) was 4.4% and 7.3%, respectively. These calculations are based on 11 cases that presented with ST segment depression alone without concomitant ST segment elevation. The total number of cases regarding ST segment depression was 21; thus, 10 cases had concomitant ST segment elevation changes in the ECG. Table 2 shows the incidence of the T wave changes by group.

Table 3 shows the relative frequency at which various anatomical regions were affected in the electrocardiogram. The percentage of ECGs that showed changes in the anterior wall was 54.4% (35.6% of ST segment elevation + 1.6% of ST segment depression + 17.2% of T wave inversion), and the percentage that showed changes in the lateral segment of the heart was 46.8%. The percentage of ECGs showing changes in the inferior heart was 21.6%, while the percentage that showed changes in the apical region was only 16%.

Serum cardiac markers

The prevalence of elevated serum cardiac markers or normal cardiac markers was calculated from the extracted data. The “not available” data cases were not considered in the calculation. The prevalence of elevated CK-MB and/or troponin in patients initially presenting with TC was 89.3%, and the prevalence of negative or normal levels of these cardiac enzymes at presentation was 10.7%.

DISCUSSION

After an exhaustive search of articles describing clinical cases of TC, with emphasis on those that provided the minimum electrocardiographic data, a large number of articles and cases were found. These were analyzed to obtain the data required for this research.

The data obtained in this study indicate a pyramidal trend in age of occurrence of TC. The peak of TC incidence occurs in the 60 s; from this point, there is a gradual decrease in TC incidence as age increases or decreases, with a steeper slope in the direction of the younger population. The high female prevalence of the disease and the age distribution of its occurrence provide support for at least one hypothesis of its pathophysiology, i.e., that lack of estrogen is an important causal factor of this syndrome[11].

A newly diagnosed disease, an upcoming operation, the induction of anesthesia, a new medication, a stress test or a major physical effort are only some of the physical stressors that can cause TC. This research show that a physical stressor is by far the most common stressor reported in TC patients. Emotional stressors are reported in a quarter of all cases and can be as serious as the death of a relative[12]; they may also be less serious, such as watching a soccer team losing[13]. The asymptomatic presentations include patients undergoing anesthesia[14] and/or medical procedures, for example, tracheal intubations[15]. In these cases, the lack of symptoms can occur due to the sedation.

The chief complaint of the TC patients varied, depending on the causative factor, the trigger stressor and the presentation of each case. TC presents as an ACS; in the latter, the most common clinical presentation is chest pain and the second is dyspnea; this suggests that chest pain and dyspnea will be the most common presentation of stress cardiomyopathy[16]. In this study, chest pain was the most common initial symptom of the cases presented, and dyspnea was the second most common symptom. Hypotension and cardiopulmonary arrest were relatively common findings, most likely because of the severity of presentation in those patients. Furthermore, the initial symptoms of TC are often related to the factors causing stress cardiomyopathy. For example, a patient with a seizure[17,18] or a stroke[19] can only present neurological signs and symptoms.

A very important tool used by physicians in emergency departments and hospital settings to evaluate chest pain, ACS and preoperative patients is the electrocardiogram, which is very easy to perform and is associated with very low cost. Although percutaneous coronary intervention and CMRI are also sometimes useful tools, and the initial suspicion of the TC is usually confirm by echocardiography; it is very important for physicians to know how the TC present in terms of electrocardiography because these findings, together with the patient’s clinical characteristics, should orient the physician to consider this syndrome as a differential diagnosis.

Notably, the definitive diagnosis of TC is confirmed by echocardiographic follow-up performed days or weeks after the initial presentation and showing normalization of the wall motion and left ventricular abnormalities. The CMRI has demonstrated value in the evaluation and follow-up of patients with TC; however, the test of choice is the echocardiography due to its low cost and accessibility[20,21](Figure 3).

Figure 3
Figure 3 Cardiac magnetic resonance imaging for Takotsubo cardiomyopathy. A: Diastole: both ventricles are distended and full of blood; B and C: Systole: both ventricles contracting; D: End of systole: the right ventricle shows a normal pattern, while the left ventricle has a ballooning shape.

Changes in the ST segment of the ECG were the most common finding in all cases; these changes are typical of the presentation of ACS and are most likely the reason for the initial management of most TC cases as ACS[22,23]. Changes in the T wave are the second most common finding in the study population. Again, changes in the T wave are very common in acute myocardial ischemia and infarction[23], explaining the frequent initial diagnosis of ACS in patients with TC. Notably, for some authors, T wave changes are the most common findings among TC patients[24]. The QT interval is prolonged in approximately 10% of patients, a substantially high incidence. There is perhaps a relationship between the QT interval measurement and TC; there is a need for more research into this possibility. The ischemic heart can present with increased QT dispersion, but this observation has not yet been proven to have any practical usefulness[25]. For the physician, it is important to know that a small percentage (approximately 6%) of TC cases present with a normal ECG during admission. There were also a few cases of multiple presentations in the study; ventricular tachycardia or ventricular fibrillation, for example, can hide the expected electrocardiographic changes.

Among the ST segment changes, ST segment elevation was the most common finding, accounting for 90% of the ST changes. It is the most common presentation of a STEMI, and in this study it occurred in more than half of all cases. Although it was present in almost 10% of incidences, ST depression was not very prominent finding; in half of the cases in which it occurred, it was accompanied by other major findings such as ST segment elevation. Other ST segment presentations, such as flattened ST segments, were not commonly found in the initial ECG at admission.

T wave changes showed a distribution similar to that of ST segment changes. The incidence of the T wave inversion was very high, approximately 92% of all T wave changes. This pattern is very common in the ischemic heart. In fact, in this study, overall T wave presentation occurred in almost one third of the patients, a very significant number. When this type of electrocardiographic change is present, TC should be considered a probable diagnosis. Other T wave presentations, such as hyperacute T wave, flattened T wave and nonspecific changes, very uncommonly presented as the only finding in the ECG.

The anatomical site most commonly affected by stress cardiomyopathy is the left ventricle, but there have been cases with right ventricular akinesis[7] and even cases in which both ventricles are affected[10]. Electrocardiographic presentations of this syndrome are highly variable. In this study, it was documented that in TC the ECG changes in frequency starting from the anterior region as the most commonly affected, followed by the lateral, the inferior and finally the septal region. The clinician must remember these patterns when making a differential diagnosis and never rule out the possibility of a TC based on the ECG.

During the initial presentation of TC patients, there is a very high prevalence of serum cardiac marker elevation, making this diagnosis consistent with ACS (specifically STEMI and NSTEMI). Some authors have indicated that the distinction between TC and ACS is reflected in the level of cardiac enzyme elevation[26,27]. These finding contain important information that should raise the physician’s clinical suspicions regarding this syndrome.

COMMENTS
Background

Takotsubo syndrome has the same presentation as acute coronary syndrome (ACS) but is usually associated with history of a trigger stressor, which can be emotional or physical. Although a number of ideas have been proposed to explain its pathophysiology, there is evidence that catecholamines and estrogen play an important role. Many physicians do not readily think of Takotsubo cardiomyopathy (TC) when presented with a patient with cardiac chest pain or even with a ST segment elevation myocardial infarction (STEMI), and other physicians are not even aware of the existence of the syndrome. For this reason, it is likely that many patients are misdiagnosed. The presentation similarities of TC with ACS include symptoms, electrocardiogram (ECG) changes and serum cardiac marker levels.

Research frontiers

In some health facilities, the initial management of a STEMI is based on intravenous fibrinolysis, which is performed without confirmation of coronary artery obstruction using percutaneous coronary intervention (PCI). Takotsubo patients can have the same presentation as STEMI patients but normal or clean coronary arteries. This and other evidence makes the PCI management of choice in STEMI patients.

Innovations and breakthroughs

Although this article does not focus on patient prognosis, it is important that future research addresses the relationship between initial presentation/initial electrocardiographic changes and prognosis. Cardiac magnetic resonance imaging is a new tool that may prove useful in both initial diagnosis and noninvasive follow-up of this syndrome.

Applications

The results of the study are important in clinical practice. They can help inform physicians to include TC in the differential diagnosis of patients who present to the emergency department with cardiac chest pain.

Terminology

TC is a condition that has acquired many names over time; these include Takotsubo syndrome, stress cardiomyopathy, apical ballooning syndrome and TC. ACS is a term applied to situations in which the blood supplied to the heart muscle is suddenly blocked; it includes unstable angina, STEMI and non-ST segment elevation myocardial infarction. Troponin and creatinine kinase (CK-MB) are cardiac markers used to classify and assist with the diagnosis of myocardial infarction. CK-MB is an isoenzyme composed of a muscle portion and a brain portion; it is very specific for myocardial muscle.

Peer review

It is necessary for every physician to know the clinical presentation of TC in its early stages. As mentioned above, this entity should be included in the differential diagnosis of “ACS” patients. The present work represents an interesting examination of value for clinical practice and stresses an important issue in the field of cardiology.

Footnotes

P- Reviewers Hung MJ, Sakabe K, Xanthos T S- Editor Gou SX L- Editor A E- Editor Lu YJ

References
1.  Dote K, Sato H, Tateishi H, Uchida T, Ishihara M. [Myocardial stunning due to simultaneous multivessel coronary spasms: a review of 5 cases]. J Cardiol. 1991;21:203-214.  [PubMed]  [DOI]  [Cited in This Article: ]
2.  Gianni M, Dentali F, Grandi AM, Sumner G, Hiralal R, Lonn E. Apical ballooning syndrome or takotsubo cardiomyopathy: a systematic review. Eur Heart J. 2006;27:1523-1529.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 900]  [Cited by in F6Publishing: 611]  [Article Influence: 60.0]  [Reference Citation Analysis (0)]
3.  Lyon AR, Rees PS, Prasad S, Poole-Wilson PA, Harding SE. Stress (Takotsubo) cardiomyopathy--a novel pathophysiological hypothesis to explain catecholamine-induced acute myocardial stunning. Nat Clin Pract Cardiovasc Med. 2008;5:22-29.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 535]  [Cited by in F6Publishing: 389]  [Article Influence: 41.2]  [Reference Citation Analysis (0)]
4.  Kawai S, Kitabatake A, Tomoike H. Guidelines for diagnosis of takotsubo (ampulla) cardiomyopathy. Circ J. 2007;71:990-992.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 240]  [Cited by in F6Publishing: 134]  [Article Influence: 17.1]  [Reference Citation Analysis (0)]
5.  Schmalfuss C. Tako-tsubo cardiomyopathy and cardiac magnetic resonance imaging. Clin Cardiol. 2011;34:145-146.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 3]  [Cited by in F6Publishing: 2]  [Article Influence: 0.3]  [Reference Citation Analysis (0)]
6.  Barker S, Solomon H, Bergin JD, Huff JS, Brady WJ. Electrocardiographic ST-segment elevation: Takotsubo cardiomyopathy versus ST-segment elevation myocardial infarction--a case series. Am J Emerg Med. 2009;27:220-226.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 9]  [Cited by in F6Publishing: 9]  [Article Influence: 0.8]  [Reference Citation Analysis (0)]
7.  Bayés de Luna A, Wagner G, Birnbaum Y, Nikus K, Fiol M, Gorgels A, Cinca J, Clemmensen PM, Pahlm O, Sclarovsky S. A new terminology for left ventricular walls and location of myocardial infarcts that present Q wave based on the standard of cardiac magnetic resonance imaging: a statement for healthcare professionals from a committee appointed by the International Society for Holter and Noninvasive Electrocardiography. Circulation. 2006;114:1755-1760.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 131]  [Cited by in F6Publishing: 20]  [Article Influence: 8.7]  [Reference Citation Analysis (0)]
8.  Muller O, Roguelov C, Pascale P. A basal variant form of the transient ‘midventricular’ and ‘apical’ ballooning syndrome. QJM. 2007;100:738-739.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 9]  [Cited by in F6Publishing: 10]  [Article Influence: 0.7]  [Reference Citation Analysis (0)]
9.  Yaoita H, Yamaki T, Mizugami H, Sakamoto N, Kawamura K, Ujiie Y, Maehara K, Maruyama Y. A case of recurrent chest pain with reversible left ventricular dysfunction and ST segment elevation on electrocardiogram. Int Heart J. 2005;46:147-152.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 5]  [Cited by in F6Publishing: 4]  [Article Influence: 0.3]  [Reference Citation Analysis (0)]
10.  Izumi K, Tada S, Yamada T. A case of Takotsubo cardiomyopathy complicated by ventricular septal perforation. Circ J. 2008;72:1540-1543.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 28]  [Cited by in F6Publishing: 9]  [Article Influence: 2.3]  [Reference Citation Analysis (0)]
11.  Kobayashi N, Hata N, Yokoyama S, Shinada T, Shirakabe A, Mizuno K. A case of Takotsubo cardiomyopathy during 5-fluorouracil treatment for rectal adenocarcinoma. J Nippon Med Sch. 2009;76:27-33.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 27]  [Cited by in F6Publishing: 23]  [Article Influence: 2.3]  [Reference Citation Analysis (0)]
12.  Ker J, Van Wyk CJ. A case of takotsubo cardiomyopathy precipitated by lumiracoxib, a selective COX-2 inhibitor. Cardiovasc J Afr. 2007;18:383-384.  [PubMed]  [DOI]  [Cited in This Article: ]
13.  Lau KC, Yiu KK, Lee KL, Ko RL, Lam YM, Lam L, Lee SW. A case of takotsubo cardiomyopathy: transient left ventricular apical ballooning. Hong Kong Med J. 2006;12:388-390.  [PubMed]  [DOI]  [Cited in This Article: ]
14.  Hayashi M, Yamada H, Agatsuma T, Nomura H, Kitahara O. A case of takotsubo-shaped hypokinesis of the left ventricle caused by a lightning strike. Int Heart J. 2005;46:933-938.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 17]  [Cited by in F6Publishing: 11]  [Article Influence: 1.1]  [Reference Citation Analysis (0)]
15.  Peraira Moral JR, Segovia Cubero J, Oteo Domínguez JF, Ortiz Oficialdegui P, Fuentes Manso R, Martín Júdez V. [A case of transient left ventricular apical ballooning with an unusual complication]. Rev Esp Cardiol. 2002;55:1328-1332.  [PubMed]  [DOI]  [Cited in This Article: ]
16.  Wedekind H, Müller JG, Ribbing M, Skurzewski P, Bozzetti C, Meyer-Krahmer HJ, Böcker D. A fatal combination in an old lady: Tako-Tsubo cardiomyopathy, long QT syndrome, and cardiac hypertrophy. Europace. 2009;11:820-822.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 10]  [Cited by in F6Publishing: 9]  [Article Influence: 0.8]  [Reference Citation Analysis (0)]
17.  Davin L, Legrand V, Legrand D. A frozen heart. Eur Heart J. 2009;30:1827.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 4]  [Cited by in F6Publishing: 4]  [Article Influence: 0.3]  [Reference Citation Analysis (0)]
18.  Teo B. A mimicry of an acute coronary syndrome. Emerg Med J. 2007;24:e25.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 1]  [Cited by in F6Publishing: 2]  [Article Influence: 0.1]  [Reference Citation Analysis (0)]
19.  Arroyo D, Panizo N, Verdalles U, Vázquez-Álvarez ME, Barraca D, Quiroga B, Luño J. Acute kidney failure in the context of a Tako-Tsubo syndrome. Nefrologia. 2011;31:493-494.  [PubMed]  [DOI]  [Cited in This Article: ]
20.  Consales G, Campiglia L, Michelagnoli G, Gallerani E, Rinaldi S, Del Pace S, De Gaudio AR. Acute left ventricular dysfunction due to Tako-tsubo syndrome after induction of general anesthesia. Minerva Anestesiol. 2007;73:655-658.  [PubMed]  [DOI]  [Cited in This Article: ]
21.  Maruyama T, Hanaoka T, Nakajima H. Acute pericarditis in the recovery phase of transient left ventricular apical ballooning syndrome (takotsubo cardiomyopathy). Intern Med. 2007;46:1857-1860.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 12]  [Cited by in F6Publishing: 9]  [Article Influence: 0.9]  [Reference Citation Analysis (0)]
22.  Nguyen H, Le C, Nguyen H, Nguyen NT. Altered mental status in an elderly woman with concurrent takotsubo syndrome and polymyalgia rheumatica: a case of treatable geriatric delirium. Perm J. 2012;16:64-66.  [PubMed]  [DOI]  [Cited in This Article: ]
23.  Nishikawa S, Ito K, Adachi Y, Katoh S, Azuma A, Matsubara H. Ampulla (‘takotsubo’) cardiomyopathy of both ventricles: evaluation of microcirculation disturbance using 99mTc-tetrofosmin myocardial single photon emission computed tomography and doppler guide wire. Circ J. 2004;68:1076-1080.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 36]  [Cited by in F6Publishing: 26]  [Article Influence: 2.3]  [Reference Citation Analysis (0)]
24.  Sakihara S, Kageyama K, Nigawara T, Kidani Y, Suda T. Ampulla (Takotsubo) cardiomyopathy caused by secondary adrenal insufficiency in ACTH isolated deficiency. Endocr J. 2007;54:631-636.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 21]  [Cited by in F6Publishing: 7]  [Article Influence: 1.5]  [Reference Citation Analysis (0)]
25.  Ono Y, Kawamura T, Ito J, Kanayama S, Miura T, Kikuchi F. Ampulla (takotsubo) cardiomyopathy associated with subarachnoid hemorrhage worsening in the late phase of vasospasm--case report. Neurol Med Chir (Tokyo). 2004;44:72-74.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 29]  [Cited by in F6Publishing: 19]  [Article Influence: 1.7]  [Reference Citation Analysis (0)]
26.  Daly MJ, Harbinson MT, Dixon LJ, Spence MS. An unusual case of mid-ventricular Takotsubo cardiomyopathy. QJM. 2010;103:695-696.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 8]  [Cited by in F6Publishing: 8]  [Article Influence: 0.7]  [Reference Citation Analysis (0)]
27.  Iengo R, Marrazzo G, Rumolo S, Accadia M, Di Donato M, Ascione L, Tuccillo B. An unusual presentation of “tako-tsubo cardiomyopathy”. Eur J Echocardiogr. 2007;8:491-494.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 7]  [Cited by in F6Publishing: 7]  [Article Influence: 0.5]  [Reference Citation Analysis (0)]
28.  Pison L, De Vusser P, Mullens W. Apical ballooning in relatives. Heart. 2004;90:e67.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 59]  [Cited by in F6Publishing: 38]  [Article Influence: 3.7]  [Reference Citation Analysis (0)]
29.  Desmet WJ, Adriaenssens BF, Dens JA. Apical ballooning of the left ventricle: first series in white patients. Heart. 2003;89:1027-1031.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 348]  [Cited by in F6Publishing: 255]  [Article Influence: 19.3]  [Reference Citation Analysis (0)]
30.  Manivannan V, Li JT, Prasad A, Campbell RL. Apical ballooning syndrome after administration of intravenous epinephrine during an anaphylactic reaction. Mayo Clin Proc. 2009;84:845-846.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 26]  [Cited by in F6Publishing: 11]  [Article Influence: 2.2]  [Reference Citation Analysis (0)]
31.  Prasad A. Apical ballooning syndrome: an important differential diagnosis of acute myocardial infarction. Circulation. 2007;115:e56-e59.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 139]  [Cited by in F6Publishing: 41]  [Article Influence: 9.9]  [Reference Citation Analysis (0)]
32.  Chandrasegaram MD, Celermajer DS, Wilson MK. Apical ballooning syndrome complicated by acute severe mitral regurgitation with left ventricular outflow obstruction--case report. J Cardiothorac Surg. 2007;2:14.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 19]  [Cited by in F6Publishing: 17]  [Article Influence: 1.4]  [Reference Citation Analysis (0)]
33.  Wang R, Souza NF, Fortes JA, Santos GJ, Faria Neto JR, Zytinski L. Apical ballooning syndrome secondary to nasal decongestant abuse. Arq Bras Cardiol. 2009;93:e75-e78.  [PubMed]  [DOI]  [Cited in This Article: ]
34.  Wani S, Glatz K, Suter Y, Jamshidi P, Erne P. “Apical ballooning” - what is the cause? J Invasive Cardiol. 2008;20:599-602.  [PubMed]  [DOI]  [Cited in This Article: ]
35.  Schmidt M, Herholz C, Block M. Apical thrombus in tako-tsubo cardiomyopathy. Heart. 2007;93:1368.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 5]  [Cited by in F6Publishing: 5]  [Article Influence: 0.4]  [Reference Citation Analysis (0)]
36.  Zaman S, Ramesh N, Kovoor P. Arrhythmogenic right ventricular cardiomyopathy presenting with intra-operative aborted sudden cardiac death and TakotsuboLike left ventricular functional abnormalities. Hellenic J Cardiol. 2009;50:330-334.  [PubMed]  [DOI]  [Cited in This Article: ]
37.  Meimoun P, Malaquin D, Benali T, Tribouilloy C. Assessment of coronary flow reserve by transthoracic Doppler echocardiography in left apical ballooning syndrome. Eur J Echocardiogr. 2008;9:78-79.  [PubMed]  [DOI]  [Cited in This Article: ]
38.  Sasaki O, Nishioka T, Akima T, Tabata H, Okamoto Y, Akanuma M, Uehata A, Takase B, Katsushika S, Isojima K. Association of takotsubo cardiomyopathy and long QT syndrome. Circ J. 2006;70:1220-1222.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 40]  [Cited by in F6Publishing: 21]  [Article Influence: 2.7]  [Reference Citation Analysis (0)]
39.  Surapaneni P, Vittala SS, Vinales KL, Najib MQ, Chaliki HP. Atypical presentation of takotsubo cardiomyopathy. Eur J Echocardiogr. 2011;12:E31.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 7]  [Cited by in F6Publishing: 5]  [Article Influence: 0.7]  [Reference Citation Analysis (0)]
40.  Park IK, Sir JJ, Jung HJ, Jo SY, Cho WH, Choi SK. Atypical takotsubo cardiomyopathy associated with nasal packing for paranasal sinus surgery. Eur J Echocardiogr. 2010;11:186-188.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 4]  [Cited by in F6Publishing: 5]  [Article Influence: 0.3]  [Reference Citation Analysis (0)]
41.  Cherian J, Kothari S, Angelis D, Atef A, Downey B, Kirkpatrick J. Atypical takotsubo cardiomyopathy: dobutamine-precipitated apical ballooning with left ventricular outflow tract obstruction. Tex Heart Inst J. 2008;35:73-75.  [PubMed]  [DOI]  [Cited in This Article: ]
42.  Lee S, Lee KJ, Yoon HS, Kang KW, Lee YS, Lee JW. Atypical transient stress-induced cardiomyopathies with an inverted Takotsubo pattern in sepsis and in the postpartal state. Tex Heart Inst J. 2010;37:88-91.  [PubMed]  [DOI]  [Cited in This Article: ]
43.  Korlakunta H, Butkevich A, Muthupillai R, Cheong BY. Biventricular takotsubo cardiomyopathy: cardiac magnetic resonance imaging as useful diagnostic tool. Tex Heart Inst J. 2011;38:88-89.  [PubMed]  [DOI]  [Cited in This Article: ]
44.  Magri CJ, Sammut MA, Fenech A. Broken heart during treadmill exercise testing: an unusual cause of ST-segment elevation. Hellenic J Cardiol. 2011;52:377-380.  [PubMed]  [DOI]  [Cited in This Article: ]
45.  Rahman A, Liu D. Broken heart syndrome - a case study. Aust Fam Physician. 2012;41:55-58.  [PubMed]  [DOI]  [Cited in This Article: ]
46.  Khallafi H, Chacko V, Varveralis N, Elmi F. “Broken heart syndrome”: catecholamine surge or aborted myocardial infarction? J Invasive Cardiol. 2008;20:E9-E13.  [PubMed]  [DOI]  [Cited in This Article: ]
47.  Demirelli S, Arslan S, Bakırcı EM, Demir O. "Broken heart" syndrome complicated by acute severe mitral regurgitation. Anadolu Kardiyol Derg. 2011;11:E31.  [PubMed]  [DOI]  [Cited in This Article: ]
48.  Latib A, Ielasi A, Montorfano M, Colombo A. Broken heart syndrome: tako-tsubo cardiomyopathy. CMAJ. 2009;180:1033-1034.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 4]  [Cited by in F6Publishing: 3]  [Article Influence: 0.3]  [Reference Citation Analysis (0)]
49.  Altman A, Nussinovitch U, Goitein O, Shoenfeld Y. “Broken heart syndrome” (Takotsubo cardiomyopathy). Isr Med Assoc J. 2011;13:643-644.  [PubMed]  [DOI]  [Cited in This Article: ]
50.  Bagga S, Sharma YP, Jain M. Cardiac dysfuntion after acute subarachnoid hemorrhage: neurogenic stress cardiomyopathy or takotsubo cardiomyopathy. Neurol India. 2011;59:304-306.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 4]  [Cited by in F6Publishing: 3]  [Article Influence: 0.4]  [Reference Citation Analysis (0)]
51.  Buchholz S, Ward MR, Bhindi R, Nelson GI, Figtree GA, Grieve SM. Cardiac thrombi in stress (tako-tsubo) cardiomyopathy: more than an apical issue? Mayo Clin Proc. 2010;85:863-864.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 13]  [Cited by in F6Publishing: 10]  [Article Influence: 1.2]  [Reference Citation Analysis (0)]
52.  Zhou JQ, Haddad F, Tremmel JA, Spin JM. A big man with a broken heart: stress-induced cardiomyopathy in a morbidly obese man. Mayo Clin Proc. 2010;85:864-865.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 3]  [Cited by in F6Publishing: 2]  [Article Influence: 0.3]  [Reference Citation Analysis (0)]
53.  Mittal M, Needham E. Case report: Takotsubo cardiomyopathy in a recently widowed woman. Am Fam Physician. 2009;80:908.  [PubMed]  [DOI]  [Cited in This Article: ]
54.  Kim HS, Chang WI, Kim YC, Yi SY, Kil JS, Hahn JY, Kang M, Lee MS, Lee SH. Catecholamine cardiomyopathy associated with paraganglioma rescued by percutaneous cardiopulmonary support: inverted Takotsubo contractile pattern. Circ J. 2007;71:1993-1995.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 25]  [Cited by in F6Publishing: 17]  [Article Influence: 1.9]  [Reference Citation Analysis (0)]
55.  Doesch C, Burgstahler C, Seeger A, Miller S, May AE. Chest pain and reversible midventricular ballooning in a woman after witnessing sudden cardiac death: a possible variant of takotsubo cardiomyopathy. Can J Cardiol. 2009;25:e22.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in F6Publishing: 2]  [Reference Citation Analysis (0)]
56.  Lopes LR, Vinhas H, Cordeiro P, Guardado J, Pereira H, Catarino C, Carrageta M. Five cases of transient left ventricular apical ballooning--the experience of a Portuguese center. Rev Port Cardiol. 2008;27:495-502.  [PubMed]  [DOI]  [Cited in This Article: ]
57.  Sealove BA, Tiyyagura S, Fuster V. Takotsubo cardiomyopathy. J Gen Intern Med. 2008;23:1904-1908.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 39]  [Cited by in F6Publishing: 20]  [Article Influence: 3.0]  [Reference Citation Analysis (0)]
58.  Inoue M, Kanaya H, Matsubara T, Uno Y, Yasuda T, Miwa K. Complete atrioventricular block associated with takotsubo cardiomyopathy. Circ J. 2009;73:589-592.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 18]  [Cited by in F6Publishing: 7]  [Article Influence: 1.4]  [Reference Citation Analysis (0)]
59.  Maréchaux S, Goldstein P, Girardie P, Ennezat PV. Contractile pattern of inverted Takotsubo cardiomyopathy: illustration by two-dimensional strain. Eur J Echocardiogr. 2009;10:332-333.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 4]  [Cited by in F6Publishing: 5]  [Article Influence: 0.3]  [Reference Citation Analysis (0)]
60.  Arias AM, Oberti PF, Pizarro R, Falconi ML, de Arenaza DP, Zeffiro S, Cagide AM. Dobutamine-precipitated Takotsubo cardiomyopathy mimicking acute myocardial infarction: a multimodality image approach. Circulation. 2011;124:e312-e315.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 22]  [Cited by in F6Publishing: 4]  [Article Influence: 2.2]  [Reference Citation Analysis (0)]
61.  Vasconcelos Filho FJ, Gomes CA, Queiroz OA, Barreto JE. Dobutamine stress echocardiography-induced broken heart syndrome (Takotsubo Syndrome). Arq Bras Cardiol. 2009;93:e5-e7.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 8]  [Cited by in F6Publishing: 2]  [Article Influence: 0.7]  [Reference Citation Analysis (0)]
62.  Margey R, Diamond P, McCann H, Sugrue D. Dobutamine stress echo-induced apical ballooning (Takotsubo) syndrome. Eur J Echocardiogr. 2009;10:395-399.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 41]  [Cited by in F6Publishing: 26]  [Article Influence: 3.2]  [Reference Citation Analysis (0)]
63.  Purvis JA, Cunningham EL, McGlinchey PG, Barr SH. Drugs, electrolytes and tako-tsubo cardiomyopathy: triple aetiology of acquired long QT syndrome and torsades de pointes. Ulster Med J. 2009;78:188-189.  [PubMed]  [DOI]  [Cited in This Article: ]
64.  Biłan A, Ignatowicz A, Mosiewicz J, Wysokiński A. Dyspnea as a dominant clinical manifestation in a patient with takotsubo cardiomyopathy treated for chronic obstructive pulmonary disease and hyperthyroidism. Pol Arch Med Wewn. 2009;119:265-268.  [PubMed]  [DOI]  [Cited in This Article: ]
65.  Lentschener C, Vignaux O, Spaulding C, Bonnichon P, Legmann P, Ozier Y. Early postoperative tako-tsubo-like left ventricular dysfunction: transient left ventricular apical ballooning syndrome. Anesth Analg. 2006;103:580-582.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 36]  [Cited by in F6Publishing: 31]  [Article Influence: 2.4]  [Reference Citation Analysis (0)]
66.  Kyuma M, Tsuchihashi K, Shinshi Y, Hase M, Nakata T, Ooiwa H, Abiru M, Hikita N, Adachi T, Shoji T. Effect of intravenous propranolol on left ventricular apical ballooning without coronary artery stenosis (ampulla cardiomyopathy): three cases. Circ J. 2002;66:1181-1184.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 95]  [Cited by in F6Publishing: 70]  [Article Influence: 5.3]  [Reference Citation Analysis (0)]
67.  Figueredo VM, Gupta S. Embolic complication of Tako-Tsubo cardiomyopathy. QJM. 2009;102:820-822.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 4]  [Cited by in F6Publishing: 3]  [Article Influence: 0.3]  [Reference Citation Analysis (0)]
68.  Naganuma M, Isoda K, Ishizaki M, Ito K, Hirano T, Uchino M. Epilepsy and takotsubo cardiomyopathy: a case report. Intern Med. 2011;50:2397-2399.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 10]  [Cited by in F6Publishing: 10]  [Article Influence: 1.0]  [Reference Citation Analysis (0)]
69.  Laínez B, Ureña M, Alvarez V, Lezaun R. Iatrogenic tako-tsubo cardiomyopathy secondary to catecholamine administration. Rev Esp Cardiol. 2009;62:1498-1499.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 18]  [Article Influence: 1.6]  [Reference Citation Analysis (0)]
70.  Haghi D, Papavassiliu T, Heggemann F, Kaden JJ, Borggrefe M, Suselbeck T. Incidence and clinical significance of left ventricular thrombus in tako-tsubo cardiomyopathy assessed with echocardiography. QJM. 2008;101:381-386.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 73]  [Cited by in F6Publishing: 63]  [Article Influence: 5.6]  [Reference Citation Analysis (0)]
71.  Di Valentino M, Balestra GM, Christ M, Raineri I, Oertli D, Zellweger MJ. Inverted Takotsubo cardiomyopathy due to pheochromocytoma. Eur Heart J. 2008;29:830.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 14]  [Cited by in F6Publishing: 13]  [Article Influence: 1.0]  [Reference Citation Analysis (0)]
72.  Stähli BE, Ruschitzka F, Enseleit F. Isolated right ventricular ballooning syndrome: a new variant of transient cardiomyopathy. Eur Heart J. 2011;32:1821.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 20]  [Cited by in F6Publishing: 17]  [Article Influence: 2.0]  [Reference Citation Analysis (0)]
73.  Vivo RP, Krim SR, Hodgson J. It’s a trap! Clinical similarities and subtle ECG differences between takotsubo cardiomyopathy and myocardial infarction. J Gen Intern Med. 2008;23:1909-1913.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 7]  [Cited by in F6Publishing: 5]  [Article Influence: 0.5]  [Reference Citation Analysis (0)]
74.  Sacha J, Maselko J, Wester A, Szudrowicz Z, Pluta W. Left ventricular apical rupture caused by takotsubo cardiomyopathy--comprehensive pathological heart investigation. Circ J. 2007;71:982-985.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 40]  [Cited by in F6Publishing: 32]  [Article Influence: 2.9]  [Reference Citation Analysis (0)]
75.  Fiol M, Carrillo A, Rodriguez A, Herrero J, García-Niebla J. Left ventricular ballooning syndrome due to vasospasm of the middle portion of the left anterior descending coronary artery. Cardiol J. 2012;19:314-316.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 9]  [Cited by in F6Publishing: 3]  [Article Influence: 1.0]  [Reference Citation Analysis (0)]
76.  Oberson M, Wyttenbach R, Gallino A. Left ventricular diverticulum associated with Takotsubo cardiomyopathy. J Invasive Cardiol. 2008;20:490-491.  [PubMed]  [DOI]  [Cited in This Article: ]
77.  Magno P, Freitas A, Gil VM. Left ventricular noncompaction: case report and literature review. Rev Port Cardiol. 2007;26:1381-1391.  [PubMed]  [DOI]  [Cited in This Article: ]
78.  Kim SJ, Morelli R. Lippi-induced cardiomyopathy. Hellenic J Cardiol. 2011;52:91-92.  [PubMed]  [DOI]  [Cited in This Article: ]
79.  Kume T, Kawamoto T, Okura H, Toyota E, Neishi Y, Watanabe N, Hayashida A, Okahashi N, Yoshimura Y, Saito K. Local release of catecholamines from the hearts of patients with tako-tsubo-like left ventricular dysfunction. Circ J. 2008;72:106-108.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 116]  [Cited by in F6Publishing: 89]  [Article Influence: 8.9]  [Reference Citation Analysis (0)]
80.  Ahn JH, Park SH, Shin WY, Lee SW, Lee SJ, Jin DK, Lee HM, Eun JY. Long QT syndrome and torsade de pointes associated with Takotsubo cardiomyopathy. J Korean Med Sci. 2011;26:959-961.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 14]  [Cited by in F6Publishing: 6]  [Article Influence: 1.4]  [Reference Citation Analysis (0)]
81.  Mahida S, Dalageorgou C, Behr ER. Long-QT syndrome and torsades de pointes in a patient with Takotsubo cardiomyopathy: an unusual case. Europace. 2009;11:376-378.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 23]  [Cited by in F6Publishing: 16]  [Article Influence: 1.8]  [Reference Citation Analysis (0)]
82.  Bianchi R, Torella D, Spaccarotella C, Mongiardo A, Indolfi C. Mediterranean jellyfish sting-induced Tako-Tsubo cardiomyopathy. Eur Heart J. 2011;32:18.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 12]  [Cited by in F6Publishing: 7]  [Article Influence: 1.1]  [Reference Citation Analysis (0)]
83.  Hwang ES, Pak HN. Mid-septal hypertrophy and apical ballooning; potential mechanism of ventricular tachycardia storm in patients with hypertrophic cardiomyopathy. Yonsei Med J. 2012;53:221-223.  [PubMed]  [DOI]  [Cited in This Article: ]  [Reference Citation Analysis (0)]
84.  Ikeda E, Hisamatsu K, Kijima Y, Mizoguchi H, Urakawa S, Kimura H, Miyaji K, Munemasa M, Fujimoto Y, Matsubara H. Morphologically unique feature of recurrent ampulla (takotsubo) cardiomyopathy. Circ J. 2009;73:371-375.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 14]  [Cited by in F6Publishing: 5]  [Article Influence: 1.1]  [Reference Citation Analysis (0)]
85.  Suzuki K, Osada N, Akasi YJ, Suzuki N, Sakakibara M, Miyake F, Maki F, Takahashi Y. An atypical case of “Takotsubo cardiomyopathy” during alcohol withdrawal: abnormality in the transient left ventricular wall motion and a remarkable elevation in the ST segment. Intern Med. 2004;43:300-305.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 44]  [Cited by in F6Publishing: 32]  [Article Influence: 2.6]  [Reference Citation Analysis (0)]
86.  Teraoka K, Kiuchi S, Takada N, Hirano M, Yamashina A. Images in cardiovascular medicine. No delayed enhancement on contrast magnetic resonance imaging with Takotsubo cardiomyopathy. Circulation. 2005;111:e261-e262.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 25]  [Cited by in F6Publishing: 5]  [Article Influence: 1.6]  [Reference Citation Analysis (0)]
87.  Hara T, Hayashi T, Izawa I, Kajiya T. Noninvasive detection of Takotsubo [corrected] cardiomyopathy using multi-detector row computed tomography. Int Heart J. 2007;48:773-778.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 8]  [Cited by in F6Publishing: 6]  [Article Influence: 0.6]  [Reference Citation Analysis (0)]
88.  Kurisu S, Inoue I, Kawagoe T, Ishihara M, Shimatani Y, Hata T, Nakama Y, Kijima Y, Kagawa E. Persistent left ventricular dysfunction in takotsubo cardiomyopathy after pacemaker implantation. Circ J. 2006;70:641-644.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 31]  [Cited by in F6Publishing: 20]  [Article Influence: 2.1]  [Reference Citation Analysis (0)]
89.  Verberne HJ, van der Heijden DJ, van Eck-Smit BL, Somsen GA. Persisting myocardial sympathetic dysfunction in takotsubo cardiomyopathy. J Nucl Cardiol. 2009;16:321-324.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 15]  [Cited by in F6Publishing: 7]  [Article Influence: 1.3]  [Reference Citation Analysis (0)]
90.  Subramanyam S, Kreisberg RA. Pheochromocytoma: a cause of ST-segment elevation myocardial infarction, transient left ventricular dysfunction, and takotsubo cardiomyopathy. Endocr Pract. 2012;18:e77-e80.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 14]  [Cited by in F6Publishing: 5]  [Article Influence: 1.8]  [Reference Citation Analysis (0)]
91.  Sanchez-Recalde A, Costero O, Oliver JM, Iborra C, Ruiz E, Sobrino JA. Images in cardiovascular medicine. Pheochromocytoma-related cardiomyopathy: inverted Takotsubo contractile pattern. Circulation. 2006;113:e738-e739.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 95]  [Cited by in F6Publishing: 24]  [Article Influence: 6.3]  [Reference Citation Analysis (0)]
92.  Barriales-Villa R, Hevia S, Santamarta-Liébana E, Morís C. [Pheochromocytoma-related cardiomyopathy or stress cardiomyopathy secondary to pheochromocytoma: is new terminology needed?]. Rev Esp Cardiol. 2008;61:432-433.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 7]  [Cited by in F6Publishing: 4]  [Article Influence: 0.5]  [Reference Citation Analysis (0)]
93.  Fuse K, Fujita T, Ebe K, Nagai T, Aizawa Y. Pneumopericardium: a rare triggering factor for Takotsubo cardiomyopathy. Intern Med. 2006;45:931-932.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 1]  [Cited by in F6Publishing: 1]  [Article Influence: 0.1]  [Reference Citation Analysis (0)]
94.  Kawano H, Matsumoto Y, Arakawa S, Satoh O, Hayano M. Premature atrial contraction induces torsades de pointes in a patient of Takotsubo cardiomyopathy with QT prolongation. Intern Med. 2010;49:1767-1773.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 2]  [Cited by in F6Publishing: 2]  [Article Influence: 0.2]  [Reference Citation Analysis (0)]
95.  Wong AK, Vernick WJ, Wiegers SE, Howell JA, Sinha AC. Preoperative Takotsubo cardiomyopathy identified in the operating room before induction of anesthesia. Anesth Analg. 2010;110:712-715.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 20]  [Cited by in F6Publishing: 10]  [Article Influence: 1.7]  [Reference Citation Analysis (0)]
96.  Kimura K, Tanabe-Hayashi Y, Noma S, Fukuda K. Images in cardiovascular medicine. Rapid formation of left ventricular giant thrombus with Takotsubo cardiomyopathy. Circulation. 2007;115:e620-e621.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 23]  [Cited by in F6Publishing: 3]  [Article Influence: 1.6]  [Reference Citation Analysis (0)]
97.  Varela U C, Bohn R R, Varleta O P, Concepción C R. [Recurrence of stress cardiomyopathy after an earthquake: report of one case]. Rev Med Chil. 2011;139:79-83.  [PubMed]  [DOI]  [Cited in This Article: ]  [Reference Citation Analysis (0)]
98.  Elkhateeb OE, Beydoun HK. Recurrent long QT syndrome and syncope in transient apical ballooning syndrome (takotsubo cardiomyopathy). Can J Cardiol. 2008;24:917-919.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 3]  [Cited by in F6Publishing: 3]  [Article Influence: 0.3]  [Reference Citation Analysis (0)]
99.  Kaushik M, Alla VM, Madan R, Arouni AJ, Mohiuddin SM. Recurrent stress cardiomyopathy with variable regional involvement: insights into etiopathogenetic mechanisms. Circulation. 2011;124:e556-e557.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 29]  [Cited by in F6Publishing: 8]  [Article Influence: 3.2]  [Reference Citation Analysis (0)]
100.  Uechi Y, Higa K. Recurrent takotsubo cardiomyopathy within a short span of time in a patient with hereditary motor and sensory neuropathy. Intern Med. 2008;47:1609-1613.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 10]  [Cited by in F6Publishing: 8]  [Article Influence: 0.8]  [Reference Citation Analysis (0)]
101.  To AC, Khan AA, Kay P, Kerr AJ. Resting systolic anterior motion of mitral valve apparatus: association with apical ballooning syndrome. Circ Heart Fail. 2008;1:84-85.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 8]  [Cited by in F6Publishing: 2]  [Article Influence: 0.7]  [Reference Citation Analysis (0)]
102.  Mehta NK, Aurigemma G, Rafeq Z, Starobin O. Reverse takotsubo cardiomyopathy: after an episode of serotonin syndrome. Tex Heart Inst J. 2011;38:568-572.  [PubMed]  [DOI]  [Cited in This Article: ]
103.  Oomura M, Terai T, Sueyoshi K, Shigeno K. Reversible cardiomyopathy as the autonomic involvement of neuroleptic malignant syndrome. Intern Med. 2004;43:1162-1165.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 5]  [Cited by in F6Publishing: 3]  [Article Influence: 0.3]  [Reference Citation Analysis (0)]
104.  Volz HC, Erbel C, Berentelg J, Katus HA, Frey N. Reversible left ventricular dysfunction resembling Takotsubo syndrome after self-injection of adrenaline. Can J Cardiol. 2009;25:e261-e262.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 21]  [Cited by in F6Publishing: 5]  [Article Influence: 1.8]  [Reference Citation Analysis (0)]
105.  Miyazaki S, Kamiishi T, Hosokawa N, Komura M, Konagai H, Sagai H, Takamoto T. Reversible left ventricular dysfunction “takotsubo” cardiomyopathy associated with hyperthyroidism. Jpn Heart J. 2004;45:889-894.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 20]  [Cited by in F6Publishing: 22]  [Article Influence: 1.2]  [Reference Citation Analysis (0)]
106.  Akashi YJ, Sakakibara M, Miyake F. Reversible left ventricular dysfunction “takotsubo” cardiomyopathy associated with pneumothorax. Heart. 2002;87:E1.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 39]  [Cited by in F6Publishing: 33]  [Article Influence: 2.1]  [Reference Citation Analysis (0)]
107.  Wissner E, Fortuin FD, Scott LR, Altemose GT. Reversible pacemaker dysfunction in a patient with transient cardiac apical ballooning syndrome: a case report. Europace. 2008;10:1105-1107.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 5]  [Cited by in F6Publishing: 3]  [Article Influence: 0.4]  [Reference Citation Analysis (0)]
108.  Papanikolaou J, Tsirantonaki M, Koukoulitsios G, Papageorgiou D, Mandila C, Karakitsos D, Karabinis A. Reversible posterior leukoencephalopathy syndrome and takotsubo cardiomyopathy: the role of echocardiographic monitoring in the ICU. Hellenic J Cardiol. 2009;50:436-438.  [PubMed]  [DOI]  [Cited in This Article: ]
109.  Bonnemeier H, Krauss T, Brunswig K, Burgdorf C. Severe headache and a broken heart. Europace. 2008;10:1115-1116.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 5]  [Cited by in F6Publishing: 6]  [Article Influence: 0.4]  [Reference Citation Analysis (0)]
110.  Haghi D, Suselbeck T, Wolpert C. Severe multivessel coronary vasospasm and left ventricular ballooning syndrome. Circ Cardiovasc Interv. 2009;2:268-269.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 10]  [Cited by in F6Publishing: 3]  [Article Influence: 0.9]  [Reference Citation Analysis (0)]
111.  Rau CM, Kauffmann M, Rau CL, Cereceda M, Castro G, Massardo T. [Tako-Tsubo syndrome: report of one case]. Rev Med Chil. 2011;139:348-352.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in F6Publishing: 1]  [Reference Citation Analysis (0)]
112.  Dahdouh Z, Roule V, Bignon M, Grollier G. [Recurrent tako tsubo related to subclinical hyperthyroidism]. Rev Esp Cardiol. 2011;64:1069-1071.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 11]  [Cited by in F6Publishing: 8]  [Article Influence: 1.1]  [Reference Citation Analysis (0)]
113.  Moriya M, Mori H, Suzuki N, Hazama M, Yano K. Six-month follow-up of takotsubo cardiomyopathy with I-123-beta-metyl-iodophenyl pentadecanoic acid and I-123-meta-iodobenzyl-guanidine myocardial scintigraphy. Intern Med. 2002;41:829-833.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 23]  [Cited by in F6Publishing: 16]  [Article Influence: 1.3]  [Reference Citation Analysis (0)]
114.  Hasdemir C, Yavuzgil O, Simsek E, Ulucan C, Cinar CS. Stress cardiomyopathy (Tako-Tsubo) following radiofrequency ablation in the right ventricular outflow tract. Europace. 2008;10:1452-1454.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 13]  [Cited by in F6Publishing: 12]  [Article Influence: 1.0]  [Reference Citation Analysis (0)]
115.  Mariano L, Vilaça I, Almeida J, Garcia M, Maciel MJ. Stress cardiomyopathy in thromboembolic arterial disease. Rev Port Cardiol. 2007;26:265-270.  [PubMed]  [DOI]  [Cited in This Article: ]
116.  Sun RH, Hu BC, Li Q. Stress-induced cardiomyopathy complicated by multiple organ failure following cephalosporin-induced anaphylaxis. Intern Med. 2012;51:895-899.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 6]  [Cited by in F6Publishing: 7]  [Article Influence: 0.7]  [Reference Citation Analysis (0)]
117.  Dandel M, Lehmkuhl HB, Schmidt G, Knosalla C, Hetzer R. Striking observations during emergency catecholamine treatment of cardiac syncope in a patient with initially unrecognized takotsubo cardiomyopathy. Circ J. 2009;73:1543-1546.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 8]  [Cited by in F6Publishing: 1]  [Article Influence: 0.7]  [Reference Citation Analysis (0)]
118.  Ionescu A. Subaortic dynamic obstruction: a contributing factor to haemodynamic instability in tako-tsubo syndrome? Eur J Echocardiogr. 2008;9:384-385.  [PubMed]  [DOI]  [Cited in This Article: ]
119.  Maruyama S, Nomura Y, Fukushige T, Eguchi T, Nishi J, Yoshinaga M, Kawano Y. Suspected takotsubo cardiomyopathy caused by withdrawal of bupirenorphine in a child. Circ J. 2006;70:509-511.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 31]  [Cited by in F6Publishing: 21]  [Article Influence: 2.1]  [Reference Citation Analysis (0)]
120.  Sato T, Hagiwara K, Nishikido A, Miyamoto S, Komiyama K, Matsuno H, Hashida H, Kobayakawa N, Akiyama O. Takotsubo (ampulla-shaped) cardiomyopathy associated with microscopic polyangiitis. Intern Med. 2005;44:251-255.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 11]  [Cited by in F6Publishing: 8]  [Article Influence: 0.7]  [Reference Citation Analysis (0)]
121.  Shah DP, Sugeng L, Goonewardena SN, Coon P, Lang RM. Images in cardiovascular medicine. Takotsubo cardiomyopathy. Circulation. 2006;113:e762.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 9]  [Cited by in F6Publishing: 3]  [Article Influence: 0.6]  [Reference Citation Analysis (0)]
122.  Lee PH, Song JK, Park IK, Sun BJ, Lee SG, Yim JH, Choi HO. Takotsubo cardiomyopathy: a case of persistent apical ballooning complicated by an apical mural thrombus. Korean J Intern Med. 2011;26:455-459.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 12]  [Cited by in F6Publishing: 9]  [Article Influence: 1.2]  [Reference Citation Analysis (0)]
123.  Merchant EE, Johnson SW, Nguyen P, Kang C, Mallon WK. Takotsubo cardiomyopathy: a case series and review of the literature. West J Emerg Med. 2008;9:104-111.  [PubMed]  [DOI]  [Cited in This Article: ]
124.  Nault MA, Baranchuk A, Simpson CS, Redfearn DP. Takotsubo cardiomyopathy: a novel “proarrhythmic” disease. Anadolu Kardiyol Derg. 2007;7 Suppl 1:101-103.  [PubMed]  [DOI]  [Cited in This Article: ]
125.  Novo G, Ferro G, Fazio G, Coppola G, Ciaramitaro G, Farinella M, Rotolo A, Caruso M, Ferrandes M, Hoffmann E. Takotsubo cardiomiopathy after acute diarrhea. Intern Med. 2010;49:903-905.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 7]  [Cited by in F6Publishing: 6]  [Article Influence: 0.6]  [Reference Citation Analysis (0)]
126.  Blázquez JA, González JM, Dalmau MJ, López J. Takotsubo cardiomyopathy after elective mitral valve replacement. Interact Cardiovasc Thorac Surg. 2010;11:117-119.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 18]  [Cited by in F6Publishing: 11]  [Article Influence: 1.6]  [Reference Citation Analysis (0)]
127.  Ramanath VS, Andrus BW, Szot CR, Kaplan AV, Robb JF. Takotsubo cardiomyopathy after midodrine therapy. Tex Heart Inst J. 2012;39:158-159.  [PubMed]  [DOI]  [Cited in This Article: ]
128.  Biswas A. Takotsubo cardiomyopathy: an uncommon cause of reversible heart failure. Singapore Med J. 2011;52:e59-e61.  [PubMed]  [DOI]  [Cited in This Article: ]
129.  Preti A, Ceddaha M, Christias M, Scemama M, Rouquette I. Takotsubo cardiomyopathy and anaesthesia. Br J Anaesth. 2010;105:236-237.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 10]  [Cited by in F6Publishing: 8]  [Article Influence: 0.9]  [Reference Citation Analysis (0)]
130.  Selke KJ, Dhar G, Cohn JM. Takotsubo cardiomyopathy associated with titration of duloxetine. Tex Heart Inst J. 2011;38:573-576.  [PubMed]  [DOI]  [Cited in This Article: ]
131.  Alves AA, Kowatsch I, Tsutsui JM, Nicolau JC, Lima MF, Mathias W. Takotsubo cardiomyopathy causing transitory ventricular dysfunction. Arq Bras Cardiol. 2008;90:e16-e19.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in F6Publishing: 1]  [Reference Citation Analysis (0)]
132.  Yeh RW, Yu PB, Drachman DE. Takotsubo cardiomyopathy complicated by cardiac tamponade: classic hemodynamic findings with a new disease. Circulation. 2010;122:1239-1241.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 19]  [Cited by in F6Publishing: 3]  [Article Influence: 1.7]  [Reference Citation Analysis (0)]
133.  Kurisu S, Ishibashi K, Kato Y, Mitsuba N, Dohi Y, Nishioka K, Kihara Y. Tako-tsubo cardiomyopathy complicated by QRS prolongation. Intern Med. 2012;51:291-294.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 3]  [Cited by in F6Publishing: 1]  [Article Influence: 0.3]  [Reference Citation Analysis (0)]
134.  Rotondi F, Manganelli F, Lanzillo T, Candelmo F, Lorenzo ED, Marino L, Stanco G. Tako-tsubo cardiomyopathy complicated by recurrent torsade de pointes in a patient with anorexia nervosa. Intern Med. 2010;49:1133-1137.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 15]  [Cited by in F6Publishing: 12]  [Article Influence: 1.4]  [Reference Citation Analysis (0)]
135.  Guevara R, Aguinaga-Meza M, Hazin MI, Hazin R, McCord J. Takotsubo cardiomyopathy complicated with acute pericarditis and cardiogenic shock. J Natl Med Assoc. 2007;99:281-283.  [PubMed]  [DOI]  [Cited in This Article: ]
136.  Ukita C, Miyazaki H, Toyoda N, Kosaki A, Nishikawa M, Iwasaka T. Takotsubo cardiomyopathy during acute adrenal crisis due to isolated adrenocorticotropin deficiency. Intern Med. 2009;48:347-352.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 18]  [Cited by in F6Publishing: 10]  [Article Influence: 1.5]  [Reference Citation Analysis (0)]
137.  van de Donk NW, America YG, Zelissen PM, Hamer BJ. Takotsubo cardiomyopathy following radioiodine therapy for toxic multinodular goitre. Neth J Med. 2009;67:350-352.  [PubMed]  [DOI]  [Cited in This Article: ]
138.  Mawad W, Guerra PG, Dubuc M, Khairy P. Tako-tsubo cardiomyopathy following transcatheter radiofrequency ablation of the atrioventricular node. Europace. 2007;9:1075-1076.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 9]  [Cited by in F6Publishing: 9]  [Article Influence: 0.6]  [Reference Citation Analysis (0)]
139.  Xu RH, Yu DQ, Ma GZ, Cai ZX, Ni CM, Chen P, Zhu ZD, Luo YH, Zhu GH, Huang JQ. Takotsubo cardiomyopathy in a 90-year-old Chinese man. Chin Med J (Engl). 2012;125:957-960.  [PubMed]  [DOI]  [Cited in This Article: ]
140.  Lisi M, Zacà V, Maffei S, Casucci F, Maggi M, Lunghetti S, Aitiani P, Carrera A, Castellani D, Favilli R. Takotsubo cardiomyopathy in a Caucasian Italian woman: case report. Cardiovasc Ultrasound. 2007;5:18.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 9]  [Cited by in F6Publishing: 7]  [Article Influence: 0.6]  [Reference Citation Analysis (0)]
141.  Rotondi F, Manganelli F, Di Lorenzo E, Marino L, Candelmo F, Alfano F, Stanco G, Rosato G. Tako-tsubo cardiomyopathy in a patient with pacemaker syndrome. Europace. 2009;11:1712-1714.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 3]  [Cited by in F6Publishing: 2]  [Article Influence: 0.3]  [Reference Citation Analysis (0)]
142.  Kawano H, Matsumoto Y, Arakawa S, Hayano M, Fijisawa H. Takotsubo cardiomyopathy in a patient with severe hyponatremia associated with syndrome of inappropriate antidiuretic hormone. Intern Med. 2011;50:727-732.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 11]  [Cited by in F6Publishing: 8]  [Article Influence: 1.1]  [Reference Citation Analysis (0)]
143.  Hutchings DC, Adlam D, Ferreira V, Karamitsos TD, Channon KM. Takotsubo cardiomyopathy in association with endogenous and exogenous thyrotoxicosis. QJM. 2011;104:433-435.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 6]  [Cited by in F6Publishing: 5]  [Article Influence: 0.5]  [Reference Citation Analysis (0)]
144.  Zuhdi AS, Yaakob ZH, Sadiq MA, Ismail MD, Undok AW, Ahmad WA. Takotsubo cardiomyopathy in association with hyperthyroidism. Medicina (Kaunas). 2011;47:219-221.  [PubMed]  [DOI]  [Cited in This Article: ]
145.  Stout BJ, Hoshide R, Vincent DS. Takotsubo cardiomyopathy in the setting of acute alcohol withdrawal. Hawaii J Med Public Health. 2012;71:193-194.  [PubMed]  [DOI]  [Cited in This Article: ]
146.  Daly MJ, Dixon LJ. Takotsubo cardiomyopathy in two preoperative patients with pain. Anesth Analg. 2010;110:708-711.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 19]  [Cited by in F6Publishing: 13]  [Article Influence: 1.6]  [Reference Citation Analysis (0)]
147.  Saito R, Takahashi T, Noshita N, Narisawa A, Negi K, Takei K, Kaneko U. Takotsubo cardiomyopathy induced by dobutamine infusion during hypertensive therapy for symptomatic vasospasm after subarachnoid hemorrhage -case report-. Neurol Med Chir (Tokyo). 2010;50:393-395.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 24]  [Cited by in F6Publishing: 16]  [Article Influence: 2.2]  [Reference Citation Analysis (0)]
148.  Silberbauer J, Hong P, Lloyd GW. Takotsubo cardiomyopathy (left ventricular ballooning syndrome) induced during dobutamine stress echocardiography. Eur J Echocardiogr. 2008;9:136-138.  [PubMed]  [DOI]  [Cited in This Article: ]
149.  Biteker M, Duran NE, Gökdeniz T, Gündüz S, Güler A, Kaya H, Yildiz M, Ozkan M. Takotsubo cardiomyopathy mimicking acute high lateral myocardial infarction. Anadolu Kardiyol Derg. 2010;10:E2-E3.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 3]  [Cited by in F6Publishing: 1]  [Article Influence: 0.3]  [Reference Citation Analysis (0)]
150.  Merli E, Sutcliffe S, Gori M, Sutherland GG. Tako-Tsubo cardiomyopathy: new insights into the possible underlying pathophysiology. Eur J Echocardiogr. 2006;7:53-61.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 144]  [Cited by in F6Publishing: 102]  [Article Influence: 9.0]  [Reference Citation Analysis (0)]
151.  Virani SS, Khan AN, Mendoza CE, Ferreira AC, de Marchena E. Takotsubo cardiomyopathy, or broken-heart syndrome. Tex Heart Inst J. 2007;34:76-79.  [PubMed]  [DOI]  [Cited in This Article: ]
152.  Chia PL, Foo D. Tako-tsubo cardiomyopathy precipitated by pheochromocytoma crisis. Cardiol J. 2011;18:564-567.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 13]  [Cited by in F6Publishing: 2]  [Article Influence: 1.4]  [Reference Citation Analysis (0)]
153.  Yazdan-Ashoori P, Nichols R, Baranchuk A. Tako-tsubo cardiomyopathy precipitated by alcohol withdrawal. Cardiol J. 2012;19:81-85.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 8]  [Cited by in F6Publishing: 3]  [Article Influence: 0.9]  [Reference Citation Analysis (0)]
154.  Shah NR, Wallis W. Takotsubo cardiomyopathy presenting as postoperative atrial fibrillation. J Postgrad Med. 2010;56:209-211.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 6]  [Cited by in F6Publishing: 6]  [Article Influence: 0.5]  [Reference Citation Analysis (0)]
155.  Volman MN, Ten Kate RW, Tukkie R. Tako Tsubo cardiomyopathy, presenting with cardiogenic shock in a 24-year-old patient with anorexia nervosa. Neth J Med. 2011;69:129-131.  [PubMed]  [DOI]  [Cited in This Article: ]
156.  Salemi VM, Atik E, Kairalla RA, Queiroz EL, Rosa LV, Kalil Filho R. Takotsubo cardiomyopathy triggered by β(2) adrenergic agonist. J Bras Pneumol. 2011;37:560-562.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 4]  [Cited by in F6Publishing: 5]  [Article Influence: 0.4]  [Reference Citation Analysis (0)]
157.  Coutance G, Cauderlier E, Gloro R, Labombarda F. Tako-tsubo cardiomyopathy triggered by severe achalasia. Rev Esp Cardiol. 2010;63:747-748.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 6]  [Article Influence: 0.5]  [Reference Citation Analysis (0)]
158.  Parker JA, Amerini AL, Autschbach R, Spillner JW. Takotsubo cardiomyopathy with concurrent multivessel obstructive coronary artery disease: proposition for a new clinical entity and first case surgical experience. Interact Cardiovasc Thorac Surg. 2012;14:108-109.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 6]  [Cited by in F6Publishing: 3]  [Article Influence: 0.6]  [Reference Citation Analysis (0)]
159.  Oe K, Mori K, Otsuji M, Konno T, Fujino N, Yamagishi M. Takotsubo cardiomyopathy with marked ST-segment elevation and electrical alternans complicated with hyperglycemic hyperosmolar state. Int Heart J. 2008;49:629-635.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 7]  [Cited by in F6Publishing: 6]  [Article Influence: 0.5]  [Reference Citation Analysis (0)]
160.  Fazal IA, Alfakih K, Walsh JT. Takotsubo cardiomyopathy. J R Soc Med. 2007;100:573-575.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 2]  [Article Influence: 0.2]  [Reference Citation Analysis (0)]
161.  Afonso L, Bachour K, Awad K, Sandidge G. Takotsubo cardiomyopathy: pathogenetic insights and myocardial perfusion kinetics using myocardial contrast echocardiography. Eur J Echocardiogr. 2008;9:849-854.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 14]  [Cited by in F6Publishing: 13]  [Article Influence: 1.1]  [Reference Citation Analysis (0)]
162.  Sacco A, Morici N, Belli O, Bossi I, Mafrici A, Klugmann S. Tako-Tsubo like syndrome triggered by meperidine. Med J Malaysia. 2011;66:520-521.  [PubMed]  [DOI]  [Cited in This Article: ]
163.  Daly MJ, Dixon LJ. Tako-tsubo cardiomyopathy presenting with acute pulmonary edema. Congest Heart Fail. 2009;15:46-48.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 2]  [Cited by in F6Publishing: 3]  [Article Influence: 0.2]  [Reference Citation Analysis (0)]
164.  Jabiri MZ, Mazighi M, Meimoun P, Amarenco P. Tako-tsubo syndrome: a cardioembolic cause of brain infarction. Cerebrovasc Dis. 2010;29:309-310.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 13]  [Cited by in F6Publishing: 12]  [Article Influence: 1.2]  [Reference Citation Analysis (0)]
165.  Madaria Marijuan Z, Andrés A, Blanco J, Ruiz L. Tako-tsubo syndrome. Atypical presentation. Rev Esp Cardiol. 2010;63:364-365.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 6]  [Article Influence: 0.5]  [Reference Citation Analysis (0)]
166.  Traullé S, Kubala M, Jarry G, Leborgne L, Hermida JS. Tako-Tsubo syndrome following status epilepticus. Neurol India. 2011;59:480-482.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 6]  [Cited by in F6Publishing: 5]  [Article Influence: 0.6]  [Reference Citation Analysis (0)]
167.  D’Amato N, Colonna P, Brindicci P, Campagna MG, Petrillo C, Cafarelli A, D’Agostino C. Tako-Tsubo syndrome in a pregnant woman. Eur J Echocardiogr. 2008;9:700-703.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 10]  [Cited by in F6Publishing: 11]  [Article Influence: 0.8]  [Reference Citation Analysis (0)]
168.  Artukoglu F, Owen A, Hemmerling TM. Tako-Tsubo syndrome in an anaesthetised patient undergoing arthroscopic knee surgery. Ann Card Anaesth. 2008;11:38-41.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 18]  [Cited by in F6Publishing: 13]  [Article Influence: 1.4]  [Reference Citation Analysis (0)]
169.  Shah BN, Simpson IA, Rakhit DJ. Takotsubo (apical ballooning) syndrome in the recovery period following dobutamine stress echocardiography: a first report. Eur J Echocardiogr. 2011;12:E5.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 14]  [Cited by in F6Publishing: 4]  [Article Influence: 1.3]  [Reference Citation Analysis (0)]
170.  Cruvinel MG, Carneiro FS, Bessa RC, Pereira e Silva Y, Marques MB. Tako-Tsubo syndrome secondary to residual neuromuscular blockade. Case report. Rev Bras Anestesiol. 2008;58:623-630.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 10]  [Cited by in F6Publishing: 1]  [Article Influence: 0.8]  [Reference Citation Analysis (0)]
171.  Lateef F. The “broken heart sydrome”: you’re likely to have it only once! Singapore Med J. 2010;51:e76-e78.  [PubMed]  [DOI]  [Cited in This Article: ]
172.  Potter B, Gobeil F, Oiknine A, Laramée P. The first case of takotsubo cardiomyopathy associated with sodium tetradecyl sulphate sclerotherapy. Can J Cardiol. 2010;26:146-148.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 5]  [Cited by in F6Publishing: 2]  [Article Influence: 0.5]  [Reference Citation Analysis (0)]
173.  Agarwal S, Lyon A, Nachev P, Everitt A. The nervous heart: a case report and discussion of an under-recognized clinical problem. QJM. 2009;102:807-809.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 3]  [Cited by in F6Publishing: 2]  [Article Influence: 0.3]  [Reference Citation Analysis (0)]
174.  Opolski G, Kochanowski J, Torbicki A, Scisło P, Kowalik R, Piotrowska-Kownacka D, Zarebiński M, Pruszczyk P, Kalarus Z. The recurrence after ten years - "mother in-law variant" of tako-tsubo syndrome. Kardiol Pol. 2010;68:557-561.  [PubMed]  [DOI]  [Cited in This Article: ]
175.  Y-Hassan S, Shahgaldi K. Thrombo-embolic renal infarction in a case of mid-ventricular takotsubo syndrome. Intern Med. 2011;50:2175-2178.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 5]  [Cited by in F6Publishing: 7]  [Article Influence: 0.5]  [Reference Citation Analysis (0)]
176.  Kurisu S, Inoue I, Kawagoe T, Ishihara M, Shimatani Y, Nakama Y, Ohkawa K, Maruhashi T, Kagawa E, Dai K. Torsade de pointes associated with bradycardia and takotsubo cardiomyopathy. Can J Cardiol. 2008;24:640-642.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 24]  [Cited by in F6Publishing: 4]  [Article Influence: 1.8]  [Reference Citation Analysis (0)]
177.  Gotyo N, Kida M, Horiuchi T, Hirata Y. Torsade de pointes associated with recurrent ampulla cardiomyopathy in a patient with idiopathic ACTH deficiency. Endocr J. 2009;56:807-815.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 13]  [Cited by in F6Publishing: 4]  [Article Influence: 1.1]  [Reference Citation Analysis (0)]
178.  Singh NK, Rehman A, Hansalia SJ. Transient apical ballooning in hypertrophic obstructive cardiomyopathy. Tex Heart Inst J. 2008;35:483-484.  [PubMed]  [DOI]  [Cited in This Article: ]
179.  Núñez Gil IJ, García-Rubira JC, Luaces Méndez M, Fernández-Ortiz A, Vivas Balcones D, González Ferrer JJ, Macaya Miguel C. [Transient left midventricular dyskinesia: clinical features of a new variant]. Rev Esp Cardiol. 2008;61:322-326.  [PubMed]  [DOI]  [Cited in This Article: ]
180.  Jayaraman L, Sethi N, Sharma S, Gautam N, Sahai C, Sood J. Transient left ventricular apical ballooning post-pneumoperitoneum: Takotsubo cardiomyopathy. A case report. Minerva Anestesiol. 2010;76:455-458.  [PubMed]  [DOI]  [Cited in This Article: ]
181.  Carxvalho SS, Ferreira A, Salomé N, Fontes P, Vieira S, Rosa P, Lobo AF, Moreira JI. Transient left ventricular apical ballooning--characterization of an increasingly common new diagnostic entity. Another case report. Rev Port Cardiol. 2007;26:551-561.  [PubMed]  [DOI]  [Cited in This Article: ]
182.  Guttormsen B, Nee L, Makielski JC, Keevil JG. Transient left ventricular apical ballooning: a review of the literature. WMJ. 2006;105:49-54.  [PubMed]  [DOI]  [Cited in This Article: ]
183.  Mrdovic I, Perunicic J, Asanin M, Matic M, Vasiljevic Z, Ostojic M. Transient left ventricular apical ballooning complicated by a mural thrombus and outflow tract obstruction in a patient with pheochromocytoma. Tex Heart Inst J. 2008;35:480-482.  [PubMed]  [DOI]  [Cited in This Article: ]
184.  Auer J, Porodko M, Berent R, Punzengruber C, Weber T, Lamm G, Eber B. Transient left ventricular apical ballooning mimicking acute coronary syndrome in four patients from central Europe. Croat Med J. 2005;46:942-949.  [PubMed]  [DOI]  [Cited in This Article: ]
185.  Arslan U, Tavil Y, Abaci A, Cengel A. Transient left ventricular apical ballooning syndrome: first series in Turkish patients. Anadolu Kardiyol Derg. 2007;7:189-190.  [PubMed]  [DOI]  [Cited in This Article: ]
186.  Barriales Villa R, Bilbao Quesada R, Iglesias Río E, Bayón Meleiro N, Mantilla González R, Penas Lado M. [Transient left ventricular apical ballooning without coronary stenoses syndrome: importance of the intraventricular pressure gradient]. Rev Esp Cardiol. 2004;57:85-88.  [PubMed]  [DOI]  [Cited in This Article: ]
187.  Guardado J, Bañuelos C, Costa J, Segura L, Villarreal S, Magri OF, Henández R, Macaya C. Transient left ventricular apical ballooning. Rev Port Cardiol. 2006;25:501-506.  [PubMed]  [DOI]  [Cited in This Article: ]
188.  Cho DK, Kim JH, Chung N. Cardiovascular flashlight. Transient mid-ventricular ballooning cardiomyopathy associated with bladder pheochromocytoma. Eur Heart J. 2009;30:1202.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 9]  [Cited by in F6Publishing: 8]  [Article Influence: 0.8]  [Reference Citation Analysis (0)]
189.  Gallego Page JC, Lafuente Gormaz C, Domínguez Rodríguez P, Cháfer Rudilla M, Fuentes Manso R, Aguilera Saldaña M. [Transient ventricular dysfunction after emotional stress]. Rev Esp Cardiol. 2004;57:1124-1127.  [PubMed]  [DOI]  [Cited in This Article: ]
190.  Sousa JM, Knobel M, Buchelle G, Sousa JA, Fisher CH, Born D, Akamine N, Knobel E. [Transient ventricular dysfunction (Takotsubo cardiomyopathy)]. Arq Bras Cardiol. 2005;84:340-342.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 19]  [Cited by in F6Publishing: 8]  [Article Influence: 1.2]  [Reference Citation Analysis (0)]
191.  Jakobson T, Svitškar N, Tamme K, Starkopf J, Karjagin J. Two cases of takotsubo syndrome related to tracheal intubation/extubation. Medicina (Kaunas). 2012;48:77-79.  [PubMed]  [DOI]  [Cited in This Article: ]
192.  Otomo S, Sugita M, Shimoda O, Terasaki H. Two cases of transient left ventricular apical ballooning syndrome associated with subarachnoid hemorrhage. Anesth Analg. 2006;103:583-586.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 27]  [Cited by in F6Publishing: 21]  [Article Influence: 1.8]  [Reference Citation Analysis (0)]
193.  Gomes CB, Veras GJ. Two-dimensional strain in Takotsubo cardiomyopathy. Arq Bras Cardiol. 2010;95:e35-e37.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 5]  [Cited by in F6Publishing: 1]  [Article Influence: 0.5]  [Reference Citation Analysis (0)]
194.  Furushima H, Chinushi M, Sanada A, Aizawa Y. Ventricular repolarization gradients in a patient with takotsubo cardiomyopathy. Europace. 2008;10:1112-1115.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 17]  [Cited by in F6Publishing: 10]  [Article Influence: 1.3]  [Reference Citation Analysis (0)]
195.  Sakai K, Ochiai H, Katayama N, Nakamura K, Arataki K, Kido T, Iwamoto H, Nakamura S, Nakanishi T. Ventricular septal perforation in a patient with takotsubo cardiomyopathy. Circ J. 2005;69:365-367.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 27]  [Cited by in F6Publishing: 21]  [Article Influence: 1.7]  [Reference Citation Analysis (0)]
196.  Hakeem A, Marks AD, Bhatti S, Chang SM. When the worst headache becomes the worst heartache! Stroke. 2007;38:3292-3295.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 18]  [Cited by in F6Publishing: 4]  [Article Influence: 1.3]  [Reference Citation Analysis (0)]