According to Mayo clinic criteria (ref. 1) the definition of tako tsubo cardiomyopathy should be made when the following conditions are excluded: Absence of recent significant head trauma, intracranial bleeding, pheochromocytoma, myocarditis and hypertrophic cardiomyopathy. However all these conditions would fall under the broader term catecholamine induced cardiomyopathy.
In a recent review of 1750 patients with takotsubo cardiomyopathy the condition was classified as one of the following types based on transthoracic echocardiography and/or left ventricular angiography: (reference 3)
Apical Type. This type is characterized by hypo-, a- or dyskinesia of midventricular and apical parts of the anterior, septal, inferior and lateral wall of the left ventricle, associated with hyperkinesia of basal segments.
Midventricular Type. This type comprises hypo-, a- or dyskinesia of midventricular segments, most often like a cuff, with normo- or hyperkinesia of basal and apical segments.
Basal Type. This type involves hypo-, a- or dyskinesia of basal segments and normo- or hyperkinesia of midventricular and anterior, anteroseptal and/or anteroapikal segments of the left ventricle. In this the basal type shows wall-motion abnormalities complementary to the apical type, as such the basal type is also referred to as “inverse” form of takotsubo cardiomyopathy.
Focal Type. This type is characterized by focal hypo-, a- or dyskinesia of any segment of the left ventricle. In most cases an anterolateral segment is involved.
Apical takotsubo cardiomyopathy was identified in 81.7% of patients, whereas the midventricular form was found in 14.6%, and basal and focal forms were diagnosed in 2.2% and 1.5%, respectively.
1571 (89.8%) were women (mean [±SD] age, 66.8±13.0 years), and 1384 of all patients (79.1%) were women older than 50 years of age.
In conclusion the presentation and clinical course of this patient are in favor of the diagnosis of a catecholamine induced cardiomyopathy of the mixed mid and basal ventricular types probably related to a pheochromocytoma. (ref. 3)
1.Yoshihiro J. Akashi, David S. Goldstein, Giuseppe Barbaro and Takashi Ueyama Takotsubo Cardiomyopathy : A New Form of Acute, Reversible Heart Failure. Circulation. 2008;118:2754-2762
2. C. Templin, J.R. Ghadri, J. Diekmann, L.C. Napp, D.R. Bataiosu et al. Clinical features and outcomes of tako tsubo cardiomyopathy New Engl J Med 2015;373:929-38.
3. Thaslim Ahamed Kassim, MD. Douglas D. Clarke, DO, Vinh Q. Mai, DO, Patrick W. Clyde, MD, FACP, FACE,
and K. M. Mohamed Shakir, MD, MACP, MACE, FRCP, FACN CATECHOLAMINE-INDUCED CARDIOMYOPATHY Endocr Pract. 2008;14:1137- 1149.