TAKOSTUBO CARDIOMYOPATHY OR BROKEN HEART SYNDROME - Medical point of view

What is Takotsubo?

The Takostubo syndrome is a heart disease from the cardiomyopathies family. It is also called the broken heart syndrome or more figuratively, apical ballooning syndrome or acute stress-induced cardiomyopathy.

There are different types of damage but it is usually the tip of the heart (apex) that is weakened.

Here is an example of coloration of a normal left ventricle:

Here is an example of cooration of a takostubo type cardiomyopathy:

Where does the term "Takotsubo" come from?

The term "Takotsubo" comes from the Japanese word for an octopus trap.

First described in Japan in 1977, the abnormal contraction of the heart caused by takotsubo resembles the traps used by Japanese hunting octopi.

How is Takotsubo explained?

This type of cardiomyopathy affects the transition aspect of the heart’s main function, or, in other words, the heart’s power to eject blood, associated with stress, whether it is of emotional or of physical nature.

The intensity of the pump is decreased.

Strong emotion or stress

When we experience strong emotions and stress, the sympathetic nervous system is activated. This part of the nervous system is activated when we are facing danger and experiencing strong emotions. It releases stimulating substances to react to these situations.

For example

Let’s say there is fire at home. You must react quickly to get out. The activation of the sympathetic nervous system allows the release of hormones such as cortisone and adrenaline into the blood to speed up your alertness, your decision-making and the speed with which you will escape the disaster.

However, very rarely, these substances may damage the heart. The precise mechanism remains unknown.

Often unnoticed

Approximately 1 to 3 % of patients who make it to the emergency with signs of a heart attack have Takotsubo.

The exact number of this type of cardiomyopathy is quite unknown since many patients will never show up at the emergency because they don’t have any symptoms.

Women are more often affected than men. In fact, it is an almost exclusive to women.

What are the symptoms?

Pain in the chest, shortness of breath and more rarely loss of consciousness are the symptoms of Takotsubo. They are similar to heart attacks and so it is impossible to initially differentiate the two.

However, the presence of identifiable emotional or physical stress favors the diagnosis of Takotsubo heart disease.

The provocative stress

Demonstrating provocative physical or mental stress is not always obvious. We must remember two things when analyzing the symptoms: first, an event can be stressful for one person and not for another, and second, stress management is simply a variable.

In general, a stressor can be clearly identified in two thirds of the cases.

The diagnosis

The diagnosis is made with the help of several elements of investigation:

- The electrocardiogram helps little.

- Echocardiography shows a left ventricle with what appears to be a balloon appearance at the tip, or in other words that the apex of the heart does not contract anymore.

- Coronary angiography, which determines the anatomy of the coronary arteries, is the best examination to exclude a myocardial infarction caused by the blockage of a coronary artery. Takotsubo often has healthy arteries, or if there are atheroma plaques, these do not have any impact on the heart muscle.

- Nuclear magnetic resonance is rarely used for this kind of cardiomyopathy. Just like an echocardiography, it can show the contraction malfunction at the apex, but also signs of inflammation of the heart muscle leading to often temporary heart damage.

How do we treat Takotsubo syndrome?

There isn’t any precise treatment for Takotsubo.

Afterwards, it is very important to monitor and treat possible complications such as heart failure, arrhythmias and, sometimes, the presence of a blood clot in the heart.

The presence of a blood clot in the heart requires treatment to thin the blood for a period of 3 to 6 months to prevent a stroke. This treatment can be prolonged depending on the echocardiographic controls.

Leave of absence may be granted depending on the severity of the damage to the heart muscle and the associated symptoms. The duration of this leave varies from one individual to another.

Follow-up

After being released from the hospital, it is important to have a follow-up with a health professional, to adopt a healthy lifestyle and to take medication as prescribed.

Does the heart recover?

Typically, in most patients, the heart functions normally again after 6 to 8 weeks. A minority of patients do not completely recover, hence the importance of taking medication diligently and adopting healthy lifestyle habits.

Can this condition return?

Recurrence is always possible, though rare. It is estimated at less than 5% of patients in the first 4 years following an episode of takotsubo.

There does not seem to be any treatment to limit this low risk, besides better stress management.

List of some stressors

Here are some stressors associated with Takostubo syndrome:

• Accident of any kind

• Aggression of any kind

• Important diseases, major surgeries

• Domestic violence

• Severe pain

• Loss of a loved one

• The announcement of bad news

• Financial loss

• Extreme fear

• Strong argumentation

• Severe asthma crisis

• Happy events

• ...

Each person is different

Once again, it is important to remember that an event can be stressful for one person and harmless for another and that stress management is varies from person to person.