Categories: Cardiology

Takotsubo Cardiomyopathy – Diagnosis, symptoms and treatment

Takotsubo Cardiomyopathy or “broken heart syndrome” is a sudden, transient cardiac syndrome that causes the left ventricle of your heart to change in shape and become enlarged. The heart muscle thus weakens and is not able to pump blood as well as required of it. Takotsubo syndrome accounts for 2% of the total acute coronary syndromes worldwide.

It’s a type of stress cardiomyopathy, as the heart weakening might be triggered by emotional stress such as rejection from a partner or death of a loved one. This leads to the medical term broken heart syndrome. Patients present with chest pain, elevated cardiac enzyme levels that mimic myocardial infarction, and may show an ST-segment elevation in ECG.

The first studied case of takotsubo cardiomyopathy was presented in Japan by Sato et al in 1991.

The name “takotsubo” has come due to the resemblance of the enlarged heart to that of the Japanese “takotsubo” octopus trap. The left ventricle of the heart develops a narrow neck and a round bottom – akin to the shape of the traditional trap.

It’s not an inherited heart condition, and is known by many names – acute stress-induced cardiomyopathy are apical ballooning, takotsubo syndrome, or just takotsubo in short.

What are the causes of Takotsubo Cardiomyopathy?

Stress is the main factor, with more than 85% cases set in motion by an emotional or physical trigger. It’s more common in postmenopausal women with a recent history of severe (mostly negative, sometimes happy) emotional or physical triggers.

Common examples of physical stress are:

  • Acute asthma
  • Surgery
  • Chemotherapy
  • Stroke
  • Physical assault
  • Acute illness
  • Sudden drop in blood pressure

Common examples of emotional stress are:

  • Bereavement (death of a loved one)
  • Debt or financial stress
  • Domestic abuse
  • Fear of public speaking
  • Fierce arguments
  • Relationship troubles
  • Betrayal
  • Receiving bad news (medical diagnosis like cancer)
  • Unexpected loss or illness or injury of self or relatives or friend or pet

There have been reports of people experiencing takotsubo after happy events like a reunion, getting married, a new job, winning a jackpot or a sporting event etc. Some also experience it after being involved in natural disasters such as an earthquake. 30% of people are able to identify the trigger that caused the condition in them.
Though the exact cause can’t be pinpointed, experts believe that surging stress hormones i.e catecholamines like adrenaline and norepinephrine “stun” the heart. This event thereby triggers changes in the heart muscle cells or the coronary blood vessels or both which prevents the left ventricle from contracting effectively.

Risk Factors

  • Sex
    More women are affected than men
  • Age
    People older than 50 are mostly affected.
  • Neurological history
    People with previous head injuries or seizure disorders have a greater risk of the broken heart syndrome.
  • Previous or current psychiatric disorder
    If one has gone through or is suffering from anxiety or depression, they pose a higher risk.

Takotsubo Cardiomyopathy Symptoms
One can mistake this as a heart attack as the symptoms often feel similar. These are:

If you are experiencing any chest pain, shortness of breath, or rapid, irregular heartbeat, call for emergency medical services immediately.

Diagnosis of Takotsubo Syndrome
The diagnosis depends on three things:
1. If a heart attack gets excluded
2. If you’re heart muscle shows signs of damage
3. If your left ventricle changes shape

Various diagnostic tests are carried out to rule out a heart attack and definitive diagnosis of takutsubo.

  • Electrocardiogram (ECG)
    Takotsubo ECG shows ST-segment elevation in particular
  • Blood test
    Cardiac biomarkers released into the blood rise rapidly in takotsubo though in heart attack they take longer
  • Echocardiogram
    It shows abnormal movements in the left ventricular wall. The major abnormality – which gives takotsubo its name – is the ballooning of the apex, i.e the lower part of the left ventricle. During contraction, it resembles the tako-tsubo pot used by Japanese fishermen to trap octopuses
  • Angiogram
    Will show no blockage in the coronary arteries as opposed to heart attacks

Cardiac Magnetic Resonance Imaging (MRI) Scan is also used at times for differential diagnosis.

Takotsubo Cardiomyopathy Treatment
The treatment is supportive in nature as it’s a transient disease and left ventricular function normalizes within two months in many people. Aspirin is seen to be very helpful, but what’s most required is further treatment that addresses lifestyle changes. One needs to know how to cope with stress.
Your doctor might prescribe you any of the following medication:

  • Diuretics – To help in fluid build-up
  • Beta-blockers and ACE inhibitors – For the ones with acute heart failure. They help in taking off the strain and helping the heart work effectively.
  • Blood-thinning medication – To combat blood clots or arrhythmia like atrial fibrillation in high-risk individuals.

Takotsubo Cardiomyopathy vs Reverse Takotsubo
Patients with reverse takotsubo, a rare variant of takotsubo, present with a different profile

  • Younger age; mean age of 36
  • Less pulmonary oedema, dyspnea, and cardiogenic shock
  • Higher level of cardiac markers

What are the complications?
In some rare cases, the takotsubo cardiomyopathy can prove to be fatal. But most people recover quickly without any long-lasting effects. Frequent complications are:

  • Pulmonary oedema (fluid backup into lungs)
  • Hypotension (low blood pressure)
  • Disruptions in heartbeat
  • Heart failure

The takotsubo syndrome ICD 10 diagnosis code is I51.81, that helps in indicating diagnosis required for medical reimbursement purposes. If you have been experiencing extreme stress and share some of the risk factors of takotsubo cardiomyopathy, consult with your physician before it’s too late.

Dr. Rajendra N.S | Consultant – Cardiology – Adult | Narayana Multispeciality Hospital, Mysore

Narayana Health

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