Vertebrates developed pulmonary circulation and septated the heart into venous and arterial compartments, as the adaptation from aquatic to terrestrial life requires more oxygen and energy. The interventricular septum (IVS) accommodates the ventricular portion of the conduction system and contributes to the mechanical function of both ventricles. Conditions or diseases that affect IVS structure and function (e.g., hypertrophy, defects, other) may lead to ventricular pump failure and/or ventricular arrhythmias with grave consequences. IVS structure and function can be evaluated today using current imaging techniques. Effective therapies can be provided in most cases, although definitions of underlying etiologies may not always be easy, particularly in the elderly due to overlap between genetic and acquired causes of IVS hypertrophy, the most common being IVS abnormality. In this review, state-of-the-art information regarding IVS morphology, physiology, physiopathology, and disease is presented.

/pdf/the-interventricular-septum-structure-function-dysfunction-1879j4wr.pdf

The Interventricular Septum: Structure, Function, Dysfunction, and Diseases

Up-to-date data on the problem of takotsubo cardiomyopathy, including data on the clinical manifestations, diagnostic algorithm and treatment approaches, as well as the prognosis of possible complications is presented in review.

Takotsubo cardiomyopathy. Literature review: clinical performance, diagnostic algorithm, treatment, prognosis. Part II

Immersion pulmonary oedema (IPO) can affect sea swimmers, snorkelers, and scuba divers. It can be fatal and cases are often mistaken for drowning. There has been an association between IPO and the development of takotsubo cardiomyopathy. We present a case study of a diver rescued from the water with IPO, who was subsequently found to have takotsubo cardiomyopathy on cardiac magnetic resonance imaging (CMR). This case demonstrates CMR findings as well as follow- up investigation results. The diver's and instructor's perspective during the initial dive incident are also described.

Takotsubo cardiomyopathy findings on cardiac magnetic resonance imaging following immersion pulmonary oedema.

Takotsubo syndrome (TTS) is characterized by apical or left ventricular (LV) ballooning and impaired wall motion as its primary features. Although women over 55 years make up the majority of TTS patients, male patients have a greater incidence of in-hospital mortality. TTS also impacts pregnant women and children, with conflicting information regarding racial differences. TTS has an in-hospital mortality rate comparable to that of acute ST-segment elevation myocardial infarction, and higher than that in patients with myocarditis. More than 10% of patients may experience a subsequent acute episode within 5 years after the initial event. TTS exhibits symptoms such as chest pain, electrocardiograph (ECG) abnormalities, elevated B-type natriuretic peptide (BNP), and N-terminal prohormone of brain natriuretic peptide (NT-pro-BNP) levels, and changes in several imaging approaches, which may aid in early diagnosis. Fluid resuscitation, β-blockers, angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), anti-anxiety or depression drugs, and cardiac rehabilitation may be employed to treat TTS, reduce recurrence rates, and improve functional exercise capacity and exercise time. After searching PubMed, Research Gate, Science Direct, and Web of Science, we summarized recent researches on epidemiology, diagnosis, treatments, and prognosis. These findings provide a theoretical basis for future clinical practice and will aid doctors and researchers investigating the unknown aspects of TTS. 

Epidemiology, diagnosis, and treatment of Takotsubo syndrome: a comprehensive review

We investigated the differences in impairment of left ventricle (LV) and left atrium (LA) contractile dysfunction between subacute and convalescent takotsubo syndrome (TTS), using myocardial strain analysis by cardiac magnetic resonance (CMR) feature-tracking technique.We retrospectively selected 50 patients with TTS clinical-radiological diagnosis who underwent CMR within 30 days since symptoms onset: 19 studied during the early subacute phase (sTTS, ≤ 7 days) and 31 during the convalescence (cTTS, 8-30 days). We measured the following: LV global longitudinal, circumferential, and radial strain (lvGLS, lvGCS, lvGRS) and strain rate (SR) and LA reservoir (laS_r), conduit (laS_cd), and booster pump strain (laS_bp) and strain rate (laSR_r, laSR_cd, laSR_bp). Patients were compared with 30 age- and sex-matched controls.All patients were women (mean age 63 years). TTS patients showed altered LV- and LA-strain features, compared to controls. sTTS was associated with increased laS_bp (12.7% versus 9.8%) and reduced lvEF (47.4% versus 54.8%), lvGLS (-12.2% versus 14.6%), and laS_cd (7.0% versus 9.5%) compared to cTTS (p ≤ 0.029). The interval between symptoms onset and CMR was correlated with laS_bp (r = -0.49) and lvGLS (r = 0.47) (p = 0.001 for both). At receiver operating characteristics analysis, laS_bp was the best discriminator between sTTS and cTTS (area under the curve [AUC] 0.815), followed by lvGLS (AUC 0.670).LA dysfunction persists during the subacute and convalescence of TTS. laS_bp increases in subacute phase with progressive decrease during convalescence, representing a compensatory mechanism of LV dysfunction and thus a useful index of functional recovery.Atrial strain has the potential to enhance the delineation of cardiac injury and functional impairment in TTS patients, assisting in the identification of individuals at higher risk and facilitating the implementation of more targeted and personalized medical therapies.• In TTS, after ventricular recovery, atrial dysfunction persists assessable with CMR feature tracking. • Quantitative assessment of atrial strain discriminates atrial functions: reservoir, conduit, and booster pump. • Atrial booster pump changes after acute TTS, regardless of ventricular function. • Atrial strain may serve as a temporal marker in TTS. 

pdf/takotsubo-syndrome-left-atrial-and-ventricular-myocardial-524hwz94er.pdf

Takotsubo syndrome: left atrial and ventricular myocardial strain impairment in the subacute and convalescent phases assessed by CMR

Primary cardiac tumors are rare. We report a case of lipomatous hypertrophy of the interventricular septum in a healthy, asymptomatic, 16 year old female, diagnosed initially by echocardiogram. Non...

https://journals.sagepub.com/doi/pdf/10.1177/11795476211024848

Imaging Findings of Lipomatous Hypertrophy of the Interventricular Septum: A Case Report.

We present a case of Takotsubo Cardiomyopathy (TC) which is a non ischemic cardiomyopathy. It is stress related and also known as broken heart syndrome. The patient presented to our emergency department with symptoms of chest pain and breathlessness. The patient was diagnosed as acute coronary syndrome and various tests including ECG, Screening ECHO, Coronary CT and Cardiac Magnetic Resonance (CMR) were done before arriving at the diagnosis of TC. Currently CMR is the modality of choice as it detects the wall motion abnormalities (WMA), presence of wall edema and late gadolinium enhancement (LGE) characteristics can be well appreciated. No intervention was done and the case was managed medically.

https://www.radiologycases.com/index.php/radiologycases/article/download/4138/pdf

Takotsubo Cardiomyopathy: Role of Cardiac MRI

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Imaging Findings of Lipomatous Hypertrophy of the Interventricular Septum: A Case Report.

Takotsubo Cardiomyopathy: Role of Cardiac MRI