Takotsubo

cardiomyopathy

, also known as transient apical ballooning syndrome, apical ballooning cardiomyopathy, stress-induced cardiomyopathy, Gebrochenes-Herz-Syndrom, and stress cardiomyopathy is a type of non-ischaemic cardiomyopathy in which there is a sudden temporary weakening of the myocardium.

• well-recognized cause of acute heart failure, lethal ventricular arrhythmias, and ventricular rupture
• triggered by emotional stress; common in postpartum women
• Presented by sudden onset of congestive heart failure associated with ECG changes suggestive of an anterior wall myocardial infarction.

Paradoxical embolisation

For a right-sided thrombus (e.g. DVT) to cause a left-sided embolism (e.g. stroke) it must obviously pass from the right-to-left side of the heart

The following cardiac lesions may cause such events

patent foramen ovale - present in around 20% of the population

atrial septal defect - a much less common cause

TOE is preferred to TTE for Dx ('coz it provides superior view of the atrial septum)

Myxoma

rare primary cardiac tumor

syncope and death due to obstruction by a "ball valve" mechanism

Use of ACE inhibitors (GISSI-3 Diabetic Subgroup Study) is associated with a 30% relative-risk reduction in the 6-week mortality rate (8.7% vs 12.4%).