Takotsubo cardiomyopathy: Heartbroken

Aliases: takotsubo cardiomyopathy, TC, stress cardiomyopathy, broken heart syndrome, left ventricular apical ballooning (it’s hard to see why this one hasn’t caught on)

Everyone knows that hearts can break, but sometimes the pain is more than just psychological, sometimes they really break. In an unfortunate display of mind over matter (seriously, why doesn’t this work with something cool, like Jedi mind tricks?), takotsubo cardiomyopathy takes the pain of heartbreak to the next level, layering physical injury on top of emotional insult. Dramatically called broken heart syndrome, takotsubo cardiomyopathy (TC) can literally arrest your heart in the wake of emotional or physical stress.

The first case of TC was documented in Japan in 19902, and by 2008, about 800 cases had been reported globally1. However, this may be a vast underestimate, as TC is difficult to diagnose and easily overlooked. One study detected the condition in 23% of intensive care unit patients with no history of structural heart disease. Because of the similarity in symptoms, TC is often mistaken for a heart attack, and accounts for 2.2% of hospital patients admitted due to a presumed heart attack1.

TC gets its name from its characteristic malformation of the heart: the left ventricle is distorted into a shape resembling a Japenese takotsubo pot, traditionally used to collect octopus2. Thankfully, while the effects of TC are serious, they are rarely fatal. In-hospital mortality is less than 1%1. The condition is often referred to as a “stunned heart”, because the injury, while profound, is temporary2. As it turns out, time may actually be the best medicine for a broken heart.

takotsubo cardiomyopathy
Love hurts.

Cause: TC is usually triggered by an emotionally (e.g. grief, fear, or relationship conflict) or physically (e.g. surgery, chemotherapy, or stroke) stressful event. While the underlying causes of TC are still unclear, it may be be a reflex response resulting from an excessive flood of hormones, such as adrenaline, released after stress2.

Consequence: The most common symptoms of TC are similar (and often initially mistaken for) a heart attack: abrupt and unpredictable chest pain, and shortness of breath. TC is distinguished by its lack of severe plaque buildup and the malformation of the heart, which causes the left ventricle to be unusually shaped (narrow necked with an enlarged lower portion that contracts poorly). Although TC can injure a large amount of heart muscle, it has very low mortality. TC mostly affects women over 50 (usually post-menopausal); only 10% of cases occur in men2.

Cure: TC is diagnosed with ultrasound and MRI, and treated with beta-blockers and angio-tensin-converting enzyme inhibitor drugs that promote heart muscle recovery. Recovery is usually rapid and complete; heart function is typically normal within 3-7 days, and 95% of patients never have recurrence, despite subsequent stress2. The heart is battered, but not broken.

References

  1. Dorfman, TA, & AE Iskandrian. (2009). Takotsubo cardiomyopathy: state-of-the-art review. Journal of Nuclear Cardiology, 16: 122-134.
  1. Sharkey, SW, JR Lesser, & BJ Maron. (2011). Takotsubo (Stress) Cardiomyopathy. Circulation, 124: e460-e462.

Image source: Creative Commons, http://pixabay.com/en/heart-broken-love-romance-damaged-297313/