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Book contents
- Frontmatter
- Contents
- List of contributors
- Preface
- Section 1 Cardiac pseudotumors and other challenging diagnoses
- Case 1 Right atrial pseudotumor due to crista terminalis
- Case 2 Cardiac pseudotumor due to lipomatous hypertrophy of the interatrial septum
- Case 3 Cardiac pseudotumor due to caseous mitral annular calcification
- Case 4 Cardiac pseudotumor due to focal hypertrophic cardiomyopathy
- Case 5 Pseudothrombus in the left ventricle due to microvascular obstruction
- Case 6 Pseudothrombus in the left atrial appendage
- Case 7 Pseudolymphadenopathy due to fluid in the pericardial recess
- Case 8 Valvular masses
- Case 9 Cardiac angiosarcoma
- Case 10 Ventricular non-compaction
- Case 11 Hypertrophic cardiomyopathy mimics
- Case 12 Stress cardiomyopathy
- Case 13 Epipericardial fat necrosis
- Section 2 Cardiac aneurysms and diverticula
- Section 3 Anatomic variants and congenital lesions
- Section 4 Coronary arteries
- Section 5 Pulmonary arteries
- Section 6 Cardiovascular MRI artifacts
- Section 7 Acute aorta and aortic aneurysms
- Section 8 Post-operative aorta
- Section 9 Mesenteric vascular
- Section 10 Peripheral vascular
- Section 11 Veins
- Index
- References
Case 12 - Stress cardiomyopathy
from Section 1 - Cardiac pseudotumors and other challenging diagnoses
Published online by Cambridge University Press: 05 June 2015
- Frontmatter
- Contents
- List of contributors
- Preface
- Section 1 Cardiac pseudotumors and other challenging diagnoses
- Case 1 Right atrial pseudotumor due to crista terminalis
- Case 2 Cardiac pseudotumor due to lipomatous hypertrophy of the interatrial septum
- Case 3 Cardiac pseudotumor due to caseous mitral annular calcification
- Case 4 Cardiac pseudotumor due to focal hypertrophic cardiomyopathy
- Case 5 Pseudothrombus in the left ventricle due to microvascular obstruction
- Case 6 Pseudothrombus in the left atrial appendage
- Case 7 Pseudolymphadenopathy due to fluid in the pericardial recess
- Case 8 Valvular masses
- Case 9 Cardiac angiosarcoma
- Case 10 Ventricular non-compaction
- Case 11 Hypertrophic cardiomyopathy mimics
- Case 12 Stress cardiomyopathy
- Case 13 Epipericardial fat necrosis
- Section 2 Cardiac aneurysms and diverticula
- Section 3 Anatomic variants and congenital lesions
- Section 4 Coronary arteries
- Section 5 Pulmonary arteries
- Section 6 Cardiovascular MRI artifacts
- Section 7 Acute aorta and aortic aneurysms
- Section 8 Post-operative aorta
- Section 9 Mesenteric vascular
- Section 10 Peripheral vascular
- Section 11 Veins
- Index
- References
Summary
Imaging findings
Stress cardiomyopathy, also known as Takotsubo cardiomyopathy or apical ballooning syndrome, is a condition characterized by chest pain simulating acute coronary syndrome. There are severe ventricular wall motion abnormalities with a notable absence of obstructive coronary artery disease. Stress cardiomyopathy is a transient phenomenon, thought to be related to an acute increase in sympathetic activity due to severe physical or emotional stress, and the vast majority of patients will have complete normalization of cardiac abnormalities at follow-up. Ventricular “ballooning” is the hallmark of the disease, characterized by akinesis or dyskinesis of ventricular walls during systole that is not confined to a single vascular territory (Figure 12.1). The ballooning occurs in the apex in more than 80% of patients. Mid-ventricular, biventricular, and basilar ballooning patterns can also be seen, although much less frequently. On cardiac MRI, transmural myocardial edema involving dyskinetic myocardial segments is present in the majority of patients. However, late gadolinium enhancement (LGE) is mostly absent. The prevalence of LGE reported in the literature ranges from 9–44% of patients, and this variability is thought to be related to interstudy differences in the threshold used to define late gadolinium enhancement. In the largest study to date evaluating 239 patients, when a standard threshold of 5 SD above remote myocardium was used to define LGE not a single patient had detectable LGE. When present, LGE may be patchy or transmural and will not conform to a vascular territory. When evaluated by cardiac CT, multiphase retrospectively-gated images will demonstrate the typical ventricular ballooning pattern and coronary arteries will be free from significant plaque (Figure 12.2).
Importance
The diagnosis of stress cardiomyopathy is challenging given its close resemblance to acute coronary syndrome, particularly since patients with stress cardiomyopathy may have EKG changes and elevated cardiac enzymes in addition to ventricular dysfunction. However, treatment and prognosis are very different between the two entities.
- Type
- Chapter
- Information
- Pearls and Pitfalls in Cardiovascular ImagingPseudolesions, Artifacts, and Other Difficult Diagnoses, pp. 41 - 44Publisher: Cambridge University PressPrint publication year: 2015