Which of the following is false about "inverted Takotsubo" cardiomyopathy?
A. In classical Takotsubo cardiomyopathy, there is apical hypo-/akinesia and basal hyperkinesis. In inverted Takotsubo, there is apical hyperkinesis and basal hypo-/akinesia.
B. It is also related to stress cardiomyopathy.
C. Clinical features are completely different from those of classical Takotsubo cardiomyopathy.
D. It has been reported in cases of pheochromocytoma, cerebrovascular accidents, severe septic condition, after amphetamine use, and postpartal state.
Answer: C
Clinical features are similar. Different patterns of anatomical involvement may be related to different sympathetic and parasympathetic innervation.
According to reference 1, four types of stress cardiomyopathy have been suggested based on different anatomical locations:
1. Classic type: apical ballooning or Takotsubo type
2. The 2nd type: the reverse type, with hyperdynamic apex and akinesia of the base
3. The 3rd type: the mid-ventricular type, involves the mid left ventricular wall, sparing the base and the apex
4. The 4th type: localized wall motion abnormality affecting a segment of the left ventricular wall, usually the anterior wall
References
1. Movahed MR, Mostafizi K. Reverse or inverted left ventricular apical ballooning syndrome (reverse Takotsubo cardiomyopathy) in a young woman in the setting of amphetamine use. Echocardiography. 2008 Apr;25(4):429-32. Epub 2008 Jan 3. (Link here, diagrams available)
2. Kim S, Yu A, Filippone LA, Kolansky DM, Raina A. Inverted-Takotsubo pattern cardiomyopathy secondary to pheochromocytoma: a clinical case and literature review.Clin Cardiol. 2010 Apr;33(4):200-5.
3. 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(1):88-91.
4. Gervais MK, Gagnon A, Henri M, Bendavid Y. Pheochromocytoma presenting as inverted Takotsubo cardiomyopathy: a case report and review of the literature.J Cardiovasc Med (Hagerstown). 2010 Feb 11. [Epub ahead of print]