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=== Cardiac Magnetic Resonance (CMR) === | === Cardiac Magnetic Resonance (CMR) === | ||
[[Cardiovascular magnetic resonance imaging (CMR)|Cardiac magnetic resonance (CMR)]] is a useful imaging modality in distinguishing between stress cardiomyopathy and [[myocarditis]] or [[MI]]. In the case of [[myocarditis]] or [[MI]], there is delayed hyper-enhancement of [[gadolinium]]. However, absence of [[gadolinium]] hyper-enhancement supports the diagnosis of stress cardiomyopathy. Also, stress cardiomyopathy results in regional wall abnormality and its extent can best be documented using [[Cardiovascular magnetic resonance imaging (CMR)|cardiac magnetic resonance]].<ref name="pmid18294473">{{cite journal |vauthors=Prasad A, Lerman A, Rihal CS |title=Apical ballooning syndrome (Tako-Tsubo or stress cardiomyopathy): a mimic of acute myocardial infarction |journal=Am. Heart J. |volume=155 |issue=3 |pages=408–17 |year=2008 |pmid=18294473 |doi=10.1016/j.ahj.2007.11.008 |url=}}</ref><ref name="pmid15687136">{{cite journal |vauthors=Sharkey SW, Lesser JR, Zenovich AG, Maron MS, Lindberg J, Longe TF, Maron BJ |title=Acute and reversible cardiomyopathy provoked by stress in women from the United States |journal=Circulation |volume=111 |issue=4 |pages=472–9 |year=2005 |pmid=15687136 |doi=10.1161/01.CIR.0000153801.51470.EB |url=}}</ref><ref name="pmid17175045">{{cite journal |vauthors=Haghi D, Fluechter S, Suselbeck T, Kaden JJ, Borggrefe M, Papavassiliu T |title=Cardiovascular magnetic resonance findings in typical versus atypical forms of the acute apical ballooning syndrome (Takotsubo cardiomyopathy) |journal=Int. J. Cardiol. |volume=120 |issue=2 |pages=205–11 |year=2007 |pmid=17175045 |doi=10.1016/j.ijcard.2006.09.019 |url=}}</ref><ref name="pmid17631086">{{cite journal |vauthors=Mitchell JH, Hadden TB, Wilson JM, Achari A, Muthupillai R, Flamm SD |title=Clinical features and usefulness of cardiac magnetic resonance imaging in assessing myocardial viability and prognosis in Takotsubo cardiomyopathy (transient left ventricular apical ballooning syndrome) |journal=Am. J. Cardiol. |volume=100 |issue=2 |pages=296–301 |year=2007 |pmid=17631086 |doi=10.1016/j.amjcard.2007.02.091 |url=}}</ref><ref name="pmid16669180">{{cite journal |vauthors=Deetjen AG, Conradi G, Mollmann S, Rad A, Hamm CW, Dill T |title=Value of gadolinium-enhanced magnetic resonance imaging in patients with Tako-Tsubo-like left ventricular dysfunction |journal=J Cardiovasc Magn Reson |volume=8 |issue=2 |pages=367–72 |year=2006 |pmid=16669180 |doi= |url=}}</ref><ref name="pmid12628715">{{cite journal |vauthors=Abe Y, Kondo M, Matsuoka R, Araki M, Dohyama K, Tanio H |title=Assessment of clinical features in transient left ventricular apical ballooning |journal=J. Am. Coll. Cardiol. |volume=41 |issue=5 |pages=737–42 |year=2003 |pmid=12628715 |doi= |url=}}</ref><ref name="pmid15687123">{{cite journal |vauthors=Dec GW |title=Recognition of the apical ballooning syndrome in the United States |journal=Circulation |volume=111 |issue=4 |pages=388–90 |year=2005 |pmid=15687123 |doi=10.1161/01.CIR.0000155234.69439.E4 |url=}}</ref><ref name="pmid19944334">{{cite journal |vauthors=Handy AD, Prasad A, Olson TM |title=Investigating genetic variation of adrenergic receptors in familial stress cardiomyopathy (apical ballooning syndrome) |journal=J Cardiol |volume=54 |issue=3 |pages=516–7 |year=2009 |pmid=19944334 |doi=10.1016/j.jjcc.2009.08.008 |url=}}</ref><ref name="pmid19167638">{{cite journal |vauthors=Sharkey SW, Maron BJ, Nelson P, Parpart M, Maron MS, Bristow MR |title=Adrenergic receptor polymorphisms in patients with stress (tako-tsubo) cardiomyopathy |journal=J Cardiol |volume=53 |issue=1 |pages=53–7 |year=2009 |pmid=19167638 |doi=10.1016/j.jjcc.2008.08.006 |url=}}</ref><ref name="pmid21771988">{{cite journal |vauthors=Eitel I, von Knobelsdorff-Brenkenhoff F, Bernhardt P, Carbone I, Muellerleile K, Aldrovandi A, Francone M, Desch S, Gutberlet M, Strohm O, Schuler G, Schulz-Menger J, Thiele H, Friedrich MG |title=Clinical characteristics and cardiovascular magnetic resonance findings in stress (takotsubo) cardiomyopathy |journal=JAMA |volume=306 |issue=3 |pages=277–86 |year=2011 |pmid=21771988 |doi=10.1001/jama.2011.992 |url=}}</ref><ref name="pmid18820322">{{cite journal |vauthors=Eitel I, Behrendt F, Schindler K, Kivelitz D, Gutberlet M, Schuler G, Thiele H |title=Differential diagnosis of suspected apical ballooning syndrome using contrast-enhanced magnetic resonance imaging |journal=Eur. Heart J. |volume=29 |issue=21 |pages=2651–9 |year=2008 |pmid=18820322 |doi=10.1093/eurheartj/ehn433 |url=}}</ref> [[Cardiovascular magnetic resonance imaging (CMR)|CMR]] in stress cardiomyopathy shows absence of irreversible damage and segmental [[LV dysfunction]].<ref name="pmid17631086">{{cite journal |vauthors=Mitchell JH, Hadden TB, Wilson JM, Achari A, Muthupillai R, Flamm SD |title=Clinical features and usefulness of cardiac magnetic resonance imaging in assessing myocardial viability and prognosis in Takotsubo cardiomyopathy (transient left ventricular apical ballooning syndrome) |journal=Am. J. Cardiol. |volume=100 |issue=2 |pages=296–301 |year=2007 |pmid=17631086 |doi=10.1016/j.amjcard.2007.02.091 |url=}}</ref> | * [[Cardiovascular magnetic resonance imaging (CMR)|Cardiac magnetic resonance (CMR)]] is a useful imaging modality in distinguishing between stress cardiomyopathy and [[myocarditis]] or [[MI]]. In the case of [[myocarditis]] or [[MI]], there is delayed hyper-enhancement of [[gadolinium]]. However, absence of [[gadolinium]] hyper-enhancement supports the diagnosis of stress cardiomyopathy. Also, stress cardiomyopathy results in regional wall abnormality and its extent can best be documented using [[Cardiovascular magnetic resonance imaging (CMR)|cardiac magnetic resonance]].<ref name="pmid18294473">{{cite journal |vauthors=Prasad A, Lerman A, Rihal CS |title=Apical ballooning syndrome (Tako-Tsubo or stress cardiomyopathy): a mimic of acute myocardial infarction |journal=Am. Heart J. |volume=155 |issue=3 |pages=408–17 |year=2008 |pmid=18294473 |doi=10.1016/j.ahj.2007.11.008 |url=}}</ref><ref name="pmid15687136">{{cite journal |vauthors=Sharkey SW, Lesser JR, Zenovich AG, Maron MS, Lindberg J, Longe TF, Maron BJ |title=Acute and reversible cardiomyopathy provoked by stress in women from the United States |journal=Circulation |volume=111 |issue=4 |pages=472–9 |year=2005 |pmid=15687136 |doi=10.1161/01.CIR.0000153801.51470.EB |url=}}</ref><ref name="pmid17175045">{{cite journal |vauthors=Haghi D, Fluechter S, Suselbeck T, Kaden JJ, Borggrefe M, Papavassiliu T |title=Cardiovascular magnetic resonance findings in typical versus atypical forms of the acute apical ballooning syndrome (Takotsubo cardiomyopathy) |journal=Int. J. Cardiol. |volume=120 |issue=2 |pages=205–11 |year=2007 |pmid=17175045 |doi=10.1016/j.ijcard.2006.09.019 |url=}}</ref><ref name="pmid17631086">{{cite journal |vauthors=Mitchell JH, Hadden TB, Wilson JM, Achari A, Muthupillai R, Flamm SD |title=Clinical features and usefulness of cardiac magnetic resonance imaging in assessing myocardial viability and prognosis in Takotsubo cardiomyopathy (transient left ventricular apical ballooning syndrome) |journal=Am. J. Cardiol. |volume=100 |issue=2 |pages=296–301 |year=2007 |pmid=17631086 |doi=10.1016/j.amjcard.2007.02.091 |url=}}</ref><ref name="pmid16669180">{{cite journal |vauthors=Deetjen AG, Conradi G, Mollmann S, Rad A, Hamm CW, Dill T |title=Value of gadolinium-enhanced magnetic resonance imaging in patients with Tako-Tsubo-like left ventricular dysfunction |journal=J Cardiovasc Magn Reson |volume=8 |issue=2 |pages=367–72 |year=2006 |pmid=16669180 |doi= |url=}}</ref><ref name="pmid12628715">{{cite journal |vauthors=Abe Y, Kondo M, Matsuoka R, Araki M, Dohyama K, Tanio H |title=Assessment of clinical features in transient left ventricular apical ballooning |journal=J. Am. Coll. Cardiol. |volume=41 |issue=5 |pages=737–42 |year=2003 |pmid=12628715 |doi= |url=}}</ref><ref name="pmid15687123">{{cite journal |vauthors=Dec GW |title=Recognition of the apical ballooning syndrome in the United States |journal=Circulation |volume=111 |issue=4 |pages=388–90 |year=2005 |pmid=15687123 |doi=10.1161/01.CIR.0000155234.69439.E4 |url=}}</ref><ref name="pmid19944334">{{cite journal |vauthors=Handy AD, Prasad A, Olson TM |title=Investigating genetic variation of adrenergic receptors in familial stress cardiomyopathy (apical ballooning syndrome) |journal=J Cardiol |volume=54 |issue=3 |pages=516–7 |year=2009 |pmid=19944334 |doi=10.1016/j.jjcc.2009.08.008 |url=}}</ref><ref name="pmid19167638">{{cite journal |vauthors=Sharkey SW, Maron BJ, Nelson P, Parpart M, Maron MS, Bristow MR |title=Adrenergic receptor polymorphisms in patients with stress (tako-tsubo) cardiomyopathy |journal=J Cardiol |volume=53 |issue=1 |pages=53–7 |year=2009 |pmid=19167638 |doi=10.1016/j.jjcc.2008.08.006 |url=}}</ref><ref name="pmid21771988">{{cite journal |vauthors=Eitel I, von Knobelsdorff-Brenkenhoff F, Bernhardt P, Carbone I, Muellerleile K, Aldrovandi A, Francone M, Desch S, Gutberlet M, Strohm O, Schuler G, Schulz-Menger J, Thiele H, Friedrich MG |title=Clinical characteristics and cardiovascular magnetic resonance findings in stress (takotsubo) cardiomyopathy |journal=JAMA |volume=306 |issue=3 |pages=277–86 |year=2011 |pmid=21771988 |doi=10.1001/jama.2011.992 |url=}}</ref><ref name="pmid18820322">{{cite journal |vauthors=Eitel I, Behrendt F, Schindler K, Kivelitz D, Gutberlet M, Schuler G, Thiele H |title=Differential diagnosis of suspected apical ballooning syndrome using contrast-enhanced magnetic resonance imaging |journal=Eur. Heart J. |volume=29 |issue=21 |pages=2651–9 |year=2008 |pmid=18820322 |doi=10.1093/eurheartj/ehn433 |url=}}</ref> | ||
* [[Cardiovascular magnetic resonance imaging (CMR)|CMR]] in stress cardiomyopathy shows absence of irreversible damage and segmental [[LV dysfunction]].<ref name="pmid17631086">{{cite journal |vauthors=Mitchell JH, Hadden TB, Wilson JM, Achari A, Muthupillai R, Flamm SD |title=Clinical features and usefulness of cardiac magnetic resonance imaging in assessing myocardial viability and prognosis in Takotsubo cardiomyopathy (transient left ventricular apical ballooning syndrome) |journal=Am. J. Cardiol. |volume=100 |issue=2 |pages=296–301 |year=2007 |pmid=17631086 |doi=10.1016/j.amjcard.2007.02.091 |url=}}</ref> | |||
Other findings on [[CMR]] include:<ref name="pmid28041712">{{cite journal |vauthors=Efferth T, Banerjee M, Paul NW |title=Broken heart, tako-tsubo or stress cardiomyopathy? Metaphors, meanings and their medical impact |journal=Int. J. Cardiol. |volume= |issue= |pages= |year=2016 |pmid=28041712 |doi=10.1016/j.ijcard.2016.12.129 |url=}}</ref><ref name="pmid20117439">{{cite journal |vauthors=Sharkey SW, Windenburg DC, Lesser JR, Maron MS, Hauser RG, Lesser JN, Haas TS, Hodges JS, Maron BJ |title=Natural history and expansive clinical profile of stress (tako-tsubo) cardiomyopathy |journal=J. Am. Coll. Cardiol. |volume=55 |issue=4 |pages=333–41 |year=2010 |pmid=20117439 |doi=10.1016/j.jacc.2009.08.057 |url=}}</ref> | Other findings on [[CMR]] include:<ref name="pmid28041712">{{cite journal |vauthors=Efferth T, Banerjee M, Paul NW |title=Broken heart, tako-tsubo or stress cardiomyopathy? Metaphors, meanings and their medical impact |journal=Int. J. Cardiol. |volume= |issue= |pages= |year=2016 |pmid=28041712 |doi=10.1016/j.ijcard.2016.12.129 |url=}}</ref><ref name="pmid20117439">{{cite journal |vauthors=Sharkey SW, Windenburg DC, Lesser JR, Maron MS, Hauser RG, Lesser JN, Haas TS, Hodges JS, Maron BJ |title=Natural history and expansive clinical profile of stress (tako-tsubo) cardiomyopathy |journal=J. Am. Coll. Cardiol. |volume=55 |issue=4 |pages=333–41 |year=2010 |pmid=20117439 |doi=10.1016/j.jacc.2009.08.057 |url=}}</ref> | ||
* [[Hypokinesia|Hypokinetic]] or [[dyskinetic]] areas in the wall of the [[heart]] | * [[Hypokinesia|Hypokinetic]] or [[dyskinetic]] areas in the wall of the [[heart]] | ||
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====MRI Examples==== | ====MRI Examples==== | ||
The | The MRI motion depictions below show a patient's heart with apical ballooning and then later after resolution of the apical ballooning. | ||
MRI during apical balllooning: | MRI during apical balllooning: | ||
Latest revision as of 20:25, 1 February 2019
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Dima Nimri, M.D. [2]
Overview
Cardiac magnetic resonance (CMR) is a useful imaging modality in distinguishing between stress cardiomyopathy and myocarditis or MI. The most common findings on CMR in patients with stress cardiomyopathy include absence of gadolinium hyper-enhancement, as well as myocardial edema.
MRI
Cardiac Magnetic Resonance (CMR)
- Cardiac magnetic resonance (CMR) is a useful imaging modality in distinguishing between stress cardiomyopathy and myocarditis or MI. In the case of myocarditis or MI, there is delayed hyper-enhancement of gadolinium. However, absence of gadolinium hyper-enhancement supports the diagnosis of stress cardiomyopathy. Also, stress cardiomyopathy results in regional wall abnormality and its extent can best be documented using cardiac magnetic resonance.[1][2][3][4][5][6][7][8][9][10][11]
- CMR in stress cardiomyopathy shows absence of irreversible damage and segmental LV dysfunction.[4]
Other findings on CMR include:[12][13]
- Hypokinetic or dyskinetic areas in the wall of the heart
- Myocardial edema
- Apical thrombi
MRI Examples
The MRI motion depictions below show a patient's heart with apical ballooning and then later after resolution of the apical ballooning.
MRI during apical balllooning: {{#ev:youtube|23w6f71zTXI}} ____
MRI following resolution of apical ballooning: {{#ev:youtube|qE0YrlQ5d1o}}
References
- ↑ Prasad A, Lerman A, Rihal CS (2008). "Apical ballooning syndrome (Tako-Tsubo or stress cardiomyopathy): a mimic of acute myocardial infarction". Am. Heart J. 155 (3): 408–17. doi:10.1016/j.ahj.2007.11.008. PMID 18294473.
- ↑ Sharkey SW, Lesser JR, Zenovich AG, Maron MS, Lindberg J, Longe TF, Maron BJ (2005). "Acute and reversible cardiomyopathy provoked by stress in women from the United States". Circulation. 111 (4): 472–9. doi:10.1161/01.CIR.0000153801.51470.EB. PMID 15687136.
- ↑ Haghi D, Fluechter S, Suselbeck T, Kaden JJ, Borggrefe M, Papavassiliu T (2007). "Cardiovascular magnetic resonance findings in typical versus atypical forms of the acute apical ballooning syndrome (Takotsubo cardiomyopathy)". Int. J. Cardiol. 120 (2): 205–11. doi:10.1016/j.ijcard.2006.09.019. PMID 17175045.
- ↑ 4.0 4.1 Mitchell JH, Hadden TB, Wilson JM, Achari A, Muthupillai R, Flamm SD (2007). "Clinical features and usefulness of cardiac magnetic resonance imaging in assessing myocardial viability and prognosis in Takotsubo cardiomyopathy (transient left ventricular apical ballooning syndrome)". Am. J. Cardiol. 100 (2): 296–301. doi:10.1016/j.amjcard.2007.02.091. PMID 17631086.
- ↑ Deetjen AG, Conradi G, Mollmann S, Rad A, Hamm CW, Dill T (2006). "Value of gadolinium-enhanced magnetic resonance imaging in patients with Tako-Tsubo-like left ventricular dysfunction". J Cardiovasc Magn Reson. 8 (2): 367–72. PMID 16669180.
- ↑ Abe Y, Kondo M, Matsuoka R, Araki M, Dohyama K, Tanio H (2003). "Assessment of clinical features in transient left ventricular apical ballooning". J. Am. Coll. Cardiol. 41 (5): 737–42. PMID 12628715.
- ↑ Dec GW (2005). "Recognition of the apical ballooning syndrome in the United States". Circulation. 111 (4): 388–90. doi:10.1161/01.CIR.0000155234.69439.E4. PMID 15687123.
- ↑ Handy AD, Prasad A, Olson TM (2009). "Investigating genetic variation of adrenergic receptors in familial stress cardiomyopathy (apical ballooning syndrome)". J Cardiol. 54 (3): 516–7. doi:10.1016/j.jjcc.2009.08.008. PMID 19944334.
- ↑ Sharkey SW, Maron BJ, Nelson P, Parpart M, Maron MS, Bristow MR (2009). "Adrenergic receptor polymorphisms in patients with stress (tako-tsubo) cardiomyopathy". J Cardiol. 53 (1): 53–7. doi:10.1016/j.jjcc.2008.08.006. PMID 19167638.
- ↑ Eitel I, von Knobelsdorff-Brenkenhoff F, Bernhardt P, Carbone I, Muellerleile K, Aldrovandi A, Francone M, Desch S, Gutberlet M, Strohm O, Schuler G, Schulz-Menger J, Thiele H, Friedrich MG (2011). "Clinical characteristics and cardiovascular magnetic resonance findings in stress (takotsubo) cardiomyopathy". JAMA. 306 (3): 277–86. doi:10.1001/jama.2011.992. PMID 21771988.
- ↑ Eitel I, Behrendt F, Schindler K, Kivelitz D, Gutberlet M, Schuler G, Thiele H (2008). "Differential diagnosis of suspected apical ballooning syndrome using contrast-enhanced magnetic resonance imaging". Eur. Heart J. 29 (21): 2651–9. doi:10.1093/eurheartj/ehn433. PMID 18820322.
- ↑ Efferth T, Banerjee M, Paul NW (2016). "Broken heart, tako-tsubo or stress cardiomyopathy? Metaphors, meanings and their medical impact". Int. J. Cardiol. doi:10.1016/j.ijcard.2016.12.129. PMID 28041712.
- ↑ Sharkey SW, Windenburg DC, Lesser JR, Maron MS, Hauser RG, Lesser JN, Haas TS, Hodges JS, Maron BJ (2010). "Natural history and expansive clinical profile of stress (tako-tsubo) cardiomyopathy". J. Am. Coll. Cardiol. 55 (4): 333–41. doi:10.1016/j.jacc.2009.08.057. PMID 20117439.