title: Cardiac rupture in takotsubo cardiomyopathy: a systematic review.
abstract: BACKGROUND
  Takotsubo cardiomyopathy (TSC) and its complications, such as cardiac rupture (CR), are increasingly being reported in the literature. CR is associated with rapid clinical decline and is uniformly fatal if not surgically repaired. To identify patients who developed CR we performed an analysis of all available indexed cases in the literature and compared them with a control group of patients with TSC without rupture.
  
  
  OBJECTIVE
  Takotsubo cardiomyopathy patients with cardiac rupture do not differ significantly from those without rupture.
  
  
  METHODS
  MEDLINE (2009) was searched for all TSC case reports with CR. Eleven case reports were identified. Using a random sampling method, we selected 12 case reports of TSC without rupture (control). We included our patient with TSC with rupture as the 12th case of TSC cohort with CR (CR group). Demographic and clinical characteristics were compared between CR group and control.
  
  
  RESULTS
  All patients in the TSC group with rupture were female and were significantly older than controls. TSC group with rupture had significantly higher frequency of ST elevation in lead II and absence of T-wave inversion in lead V5 on hospital admission than controls. Mean ejection fraction, systolic blood pressure, and double product, a measure of oxygen demand, was significantly higher in the rupture group compared to controls. The CR group was associated with less frequent use of β-blocker as compared to controls.
  
  
  CONCLUSIONS
  CR as a complication of TSC could be more common than recognized. Higher double product and ejection fraction suggest higher fluctuation of intracardiac pressure and may cause CR in TSC. Use of β blockers in TSC may provide protection against CR.
authors.affiliation: Department of Cardiovascular Medicine, SUNY Downstate Medical Center, Brooklyn, New York 11203, USA. kumarsanjay@sbcglobal.net
authors.forename: Sanjay
authors.initials: S
authors.lastname: Kumar
authors.forename: Sashank
authors.initials: S
authors.lastname: Kaushik
authors.forename: Amit
authors.initials: A
authors.lastname: Nautiyal
authors.forename: Sujit K
authors.initials: SK
authors.lastname: Choudhary
authors.forename: Bhuwan L
authors.initials: BL
authors.lastname: Kayastha
authors.forename: Nelson
authors.initials: N
authors.lastname: Mostow
authors.forename: Jason M
authors.initials: JM
authors.lastname: Lazar
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D005260:Female; D006341:Heart Rupture / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D012307:Risk Factors; D013318:Stroke Volume; D054549:Takotsubo Cardiomyopathy / Q000150:complications* / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology; D016896:Treatment Outcome; D016277:Ventricular Function, Left
chemical_list: D000319:Adrenergic beta-Antagonists