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Takotsubo Cardiomyopathy: Definition, Symptoms & Causes

Instructor: Artem Cheprasov
This lesson will explore takotsubo cardiomyopathy, a condition which has been called 'broken-heart syndrome' because of its connection with deeply felt personal losses. Here we explore the causes, symptoms, and treatment of the disease as well as its diagnostic origin.

A Real Broken Heart?

Let's say you're a doctor already. Is it possible for a patient of yours to suffer from a broken heart? No, literally. Can they do so? It's actually possible, because there is something called the broken-heart syndrome. It's also been called stress-induced cardiomyopathy and transient apical ballooning syndrome. More commonly, though, it's known as takotsubo cardiomyopathy, a rare but important heart condition most often encountered in women.

All of this will make sense in a second as we go over this condition and its signs, symptoms, and treatments in this lesson.

More on Takotsubo Cardiomyopathy

First, let's clear up that terminological confusion by describing this condition in more detail. When a person is in severe psychological and/or physiological stress, they might develop stress-induced cardiomyopathy, where cardiomyopathy refers to a problem of the heart. Forms of stress that can lead to this include a serious accident, extreme pain, domestic abuse, natural disasters like an earthquake, the loss of a loved one, and so on. Hence the term broken-heart syndrome.

One of the more statistically rare forms of cardiomyopathy, this stress-induced cardiomyopathy is called takotsubo cardiomyopathy. It gets its name from the traditional Japanese 'takotsubo', which is a narrow-necked fishing pot that is used to trap an octopus. In takotsubo cardiomyopathy, the left ventricle of the heart assumes the general shape of this pot during systole, which is when it contracts to push blood forward into general circulation.

More specifically, during systole the 'bottom' (apical) and mid segments of the left ventricle dysfunction and do not move well, if at all. As compensation for this dysfunction, the top (basal) walls of the ventricle increase their muscular activity. This causes the bottom (apex) of the left ventricle to balloon during systole. Hence the term: transient apical ballooning syndrome.

The darker space represents the left ventricle, shaped like a takotsubo pot during this condition.
t

On the left, the arrows show how the apex of the left ventricle balloons in this condition.
a

Hard to imagine why this happens? Fill a balloon with air or water. Tie it up. Now squeeze one end of the balloon. What'll happen? The air will move to, and 'balloon', the end that isn't being squeezed, right? Well, that's sort of what happens here.

Now you know more about this syndrome and why it has so many different names.

Signs & Symptoms

So let's say you're a doctor at an ER. What signs and symptoms would you look for to help diagnose this condition? First, you'd need to assess who your patient is. Women, especially those aged 58-75, make up 90% of reported cases. Jill, your patient, is 65 so she fits the bill so far.

Next, you're told that Jill came in to the ER not long after the love of her life, her husband of 45 years, passed away. So now we know a severe psychological stressor has taken place. Again, things seem to be lining up.

She seems to be complaining of heart attack-like signs and symptoms which is very similar to what you'd see in Takotsubo cardiomyopathy. This means she tells you she has sign and symptoms like:

  • Chest pain (angina)
  • Shortness of breath or difficulty breathing (dyspnea)
  • Syncope, or fainting

You start running some tests, and note a ventricular arrhythmias, or irregular heartbeats stemming from a problem of the lower chambers of the heart. This can happen in Takotsubo cardiomyopathy as well. You'd need to run other tests to distinguish an actual heart attack from takotsubo cardiomyopathy, but those details are beyond this lesson's scope.

Treatment

So let's say you've diagnosed Jill with a broken heart. The bad news? Up to 20% of people can develop heart failure as a consequence of this disorder. The good news? Very few people die from a broken heart and most people recover within a month to a month and a half.

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