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.
HYPOTHESIS: 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.