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TAKOTSUBO CARDIOMYOPATHY

Takotsubo cardiomyopathy is a temporary heart condition that occurs predominantly in women. Its tendency to occur after severe emotional stress has given it the nickname “broken-heart syndrome.” Takotsubo cardiomyopathy is a weakening of the left ventricle after severe emotional or physical stress. The left ventricle balloons atypically. During systole, the mid section and apex balloon out while the base contracts normally. The shape is similar to that of a Japanese vessel used to catch octopuses called a takotsubo, hence the name. The exact mechanism is unclear, but experts think that a sudden surge in stress hormones, such as adrenaline, stuns the heart and triggers changes in heart muscle cells or coronary blood vessels that prevent the left ventricle from contracting effectively. Older women may be more vulnerable because of reduced levels of estrogen after menopause. Average age of onset is between 58-75 years. Less than 3% of cases occur in patients under age 50. Takotsubo cardiomyopathy can cause acute heart failure, lethal ventricular arrhythmias, and ventricular rupture.

Takotsubo cardiomyopathy has the following signs and symptoms:

  • Chest pain and shortness of breath after severe stress (emotional or physical)
  • Electrocardiogram abnormalities that mimic those of a heart attack
  • No evidence of coronary artery obstruction
  • Movement abnormalities in the left ventricle
  • Ballooning of the left ventricle
  • Recovery within a month

It is almost indistinguishable from a myocardial infarction. An EKG may also show ST-segment elevation. Other tests may be used to rule out a heart attack. An angiogram may be done to see if there is evidence of blockage of the coronary arteries. Cardiac biomarkers may show a small but rapid rise. In a heart attack, the biomarkers take longer to rise but peak higher. An echocardiogram may show the atypical ballooning of the left ventricle.

Takotsubo cardiomyopathy is temporary and usually resolves within a month. Clinicians usually prescribe beta-blockers, ACE inhibitors, and diuretics. They may also give aspirin to patients who have athereosclerosis. Beta blockers may be used long term to prevent recurrence by reducing the effects of adrenaline and other stress hormones. It is also important to identify and alleviate the underlying physical or emotional stress.

Most of the abnormalities in systolic function clear up in 1-4 weeks and most patients recover fully within two months. Intra-aortic balloon pump, fluids, and negative ionotropes such as beta blockers and calcium channel blockers may be used for treatment. Death is rare, but heart failure occurs in about 20% of the patients. It is treated with diuretics. Treatment with ionotropes can worsen the condition since the disease is due to a high catecholamine state. Rare complications include arrhythmias, obstruction of blood flow from the left ventricle, and rupture of the ventricle wall.

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