Takotsubo Cardiomyopathy Vs HOCM

Takotsubo Cardiomyopathy vs Obstructive Hypertrophic Cardiomyopathy (HOCM)

Takotsubo Cardiomyopathy Vs HOCM

Takotsubo cardiomyopathy, also known as stress-induced or “broken heart” cardiomyopathy, typically occurs after intense emotional or physical stress leading to a surge in catecholamines. It causes transient left ventricular dysfunction, most characteristically apical ballooning with basal hyperkinesis on echocardiography. The left ventricle usually has normal wall thickness, and any left ventricular outflow tract (LVOT) obstruction, if present, is mild or transient. Coronary angiography reveals normal coronary arteries, and left ventricular function generally recovers within days to weeks. On ECG, Takotsubo may mimic acute myocardial infarction with ST-segment elevation, deep T-wave inversions, and QT prolongation. Prognosis is usually favorable once the stress trigger is resolved.

In contrast, obstructive hypertrophic cardiomyopathy (HOCM) is a chronic, genetic disorder caused by sarcomeric gene mutations leading to asymmetric septal hypertrophy. This thickening produces a fixed or dynamic LVOT obstruction due to systolic anterior motion (SAM) of the mitral valve. Echocardiography shows a hypertrophied basal septum, a resting or provoked LVOT gradient greater than 30 mmHg, and dynamic mitral regurgitation. The ejection fraction is often normal or hyperdynamic. ECG findings typically include voltage criteria for left ventricular hypertrophy and deep, narrow Q waves in inferior and lateral leads. Unlike Takotsubo, the structural changes in HOCM are permanent and may predispose to arrhythmias and sudden cardiac death.

In summary, Takotsubo represents a transient “stunned” ventricle after stress with reversible apical ballooning, while obstructive HCM represents a genetically “thickened” heart with persistent LVOT obstruction. In simple terms: Takotsubo is the broken heart; HOCM is the thick heart.