Stress cardiomyopathy classification

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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] Arzu Kalayci, M.D. [3]

Stress cardiomyopathy Microchapters



Historical Perspective




Differentiating Stress Cardiomyopathy from other Diseases

Epidemiology and Demographics

Risk Factors


Natural History, Complications and Prognosis


Diagnostic Criteria

History and Symptoms

Physical Examination

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Chest X Ray




Other Imaging Findings

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Medical Therapy


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Cost-Effectiveness of Therapy

Unstable angina/non ST elevation myocardial infarction in Stress (Takotsubo) Cardiomyopathy

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Case #1

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Stress cardiomyopathy can be divided into several types, depending on the location of regional wall motion abnormality. The area of motion abnormality (whether hypokinesia, dyskinesia or akinesia) can be detected on echocardiography or left ventriculography. The most common type is the apical type, resulting in apical ballooning. In a minority of patients reverse takotsubo have been described in which unlike apical ballooning the basal and mid ventricular segments of the left ventricle become akinetic.


Stress cardiomyopathy can affect different segments of the heart. The region of wall motion abnormality can be detected on echocardiography or left ventriculography. The most common type of stress cardiomyopathy is the apical type, which results in hypokinesia of the apical and mid-ventricular segments. Stress cardiomyopathy can be divided according to location of wall motion abnormality into:[1][2][3][4]

Type of Stress Cardiomyopathy Location of Wall Motion Abnormality Incidence (%) Properties
Typical Type(s) Apical Type 81.7
Atypical Type(s) Mid-ventricular Type 14.6
Basal Type

(Reverse Takotsubo)

Focal Type 1.5
Global Type Very rare


  1. Templin C, Ghadri JR, Diekmann J, Napp LC, Bataiosu DR, Jaguszewski M, Cammann VL, Sarcon A, Geyer V, Neumann CA, Seifert B, Hellermann J, Schwyzer M, Eisenhardt K, Jenewein J, Franke J, Katus HA, Burgdorf C, Schunkert H, Moeller C, Thiele H, Bauersachs J, Tschöpe C, Schultheiss HP, Laney CA, Rajan L, Michels G, Pfister R, Ukena C, Böhm M, Erbel R, Cuneo A, Kuck KH, Jacobshagen C, Hasenfuss G, Karakas M, Koenig W, Rottbauer W, Said SM, Braun-Dullaeus RC, Cuculi F, Banning A, Fischer TA, Vasankari T, Airaksinen KE, Fijalkowski M, Rynkiewicz A, Pawlak M, Opolski G, Dworakowski R, MacCarthy P, Kaiser C, Osswald S, Galiuto L, Crea F, Dichtl W, Franz WM, Empen K, Felix SB, Delmas C, Lairez O, Erne P, Bax JJ, Ford I, Ruschitzka F, Prasad A, Lüscher TF (2015). "Clinical Features and Outcomes of Takotsubo (Stress) Cardiomyopathy". N. Engl. J. Med. 373 (10): 929–38. doi:10.1056/NEJMoa1406761. PMID 26332547.
  2. Kurowski V, Kaiser A, von Hof K, Killermann DP, Mayer B, Hartmann F, Schunkert H, Radke PW (2007). "Apical and midventricular transient left ventricular dysfunction syndrome (tako-tsubo cardiomyopathy): frequency, mechanisms, and prognosis". Chest. 132 (3): 809–16. doi:10.1378/chest.07-0608. PMID 17573507.
  3. 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.
  4. Win CM, Pathak A, Guglin M (2011). "Not takotsubo: a different form of stress-induced cardiomyopathy--a case series". Congest Heart Fail. 17 (1): 38–41. doi:10.1111/j.1751-7133.2010.00195.x. PMID 21272226.

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