What are the other Names for this Condition? (Also known as/Synonyms)

• Broken Heart Syndrome
• Stress-Induced Cardiomyopathy
• TCM (Takotsubo Cardiomyopathy)

What is Takotsubo Cardiomyopathy? (Definition/Background Information)

• Takotsubo Cardiomyopathy (TCM) is a temporary and reversible heart condition. The condition mimics a heart attack and is typically brought about by stress and emotional disturbance in an individual’s life. TCM occurs predominantly in older women
• The condition was first described in 1990 in Japan. The term is Japanese and translates to “octopus trap or pot,” indicating the shape of the left ventricle in this condition (i.e., round bottom with a narrow neck)
• Any situation that can cause extreme stress can trigger Takotsubo Cardiomyopathy. Some risk factors include accidents, extreme fear, anxiety over health, getting bad news, physical/emotional abuse, and a sudden drop in blood pressure
• The exact cause of Takotsubo Cardiomyopathy is not known. It is believed that certain ‘triggers’ increase the levels of stress hormones rapidly, stunning the heart muscles. Consequently, the ventricle is rendered temporarily ineffective in pumping blood
• The signs and symptoms of Takotsubo Cardiomyopathy include shortness of breath, chest pain, irregular heartbeats, and cardiogenic shock (a reduction in blood being pumped to various body parts). Some potential complications of TCM include heart failure and fluid in the lungs
• Takotsubo Cardiomyopathy is diagnosed based on physical examination, assessment of symptoms, assessing the stress level of the affected individual, blood test to check for cardiac biomarkers, angiography and imaging studies of the heart
• Medications to treat arrhythmia and pain may be prescribed. Any underlying medical condition(s) may also need to be treated, to allow the affected individual to recover
• Although the prognosis of Takotsubo Cardiomyopathy is favorable with possibility of a full recovery in most individuals, some are known to succumb to the condition owing to complications

Who gets Takotsubo Cardiomyopathy? (Age and Sex Distribution)

• The exact prevalence of Takotsubo Cardiomyopathy worldwide is not known
• TCM is reported primarily in women aged 58-75 years. Of all the women seeking medical attention for heart attack, about 5% are reported to have TCM
• The condition can occur in both male and female genders
• All racial groups and ethnicities may be at risk, even though the condition is not reported widely

What are the Risk Factors for Takotsubo Cardiomyopathy? (Predisposing Factors)

The following are some known risk factors for Takotsubo Cardiomyopathy:

• Female gender
• Emotional stress that may include any of the following:
  • Death in the family
  • Illness
  • Anxiety over a medical procedure, surgery, prognosis, or test result
  • Emotional and/or physical abuse
  • Loss of job or a financial setback
  • Extreme fear
  • Glossophobia, or dread of addressing an audience (speech anxiety)
• Accident/injuries
• Having undergone a major surgery
• An attack of asthma
• Anxiety disorder
• Smoking habit, alcoholism
• Hyperlipidemia (elevated lipid levels in blood)

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Takotsubo Cardiomyopathy? (Etiology)

The exact cause of Takotsubo Cardiomyopathy is not known. However, because many individuals diagnosed with TCM have recently undergone an extreme physical stress or emotional upheaval in their lives, such traumatic experiences are believed to cause the condition.

• Extreme stress leads to a surge in stress hormone (adrenaline and cortisol) levels. There is a resultant, rapid increase in one’s heart rate and blood pressure
• This shocks the heart, leading to changes in the heart muscle and/or blood circulation. These changes interfere with the proper contraction of the left ventricle, causing the symptoms
• In women, estrogen plays a role in protecting the heart. This is probably the reason why TCM is more prevalent in post-menopausal women

What are the Signs and Symptoms of Takotsubo Cardiomyopathy?

The signs and symptoms of Takotsubo Cardiomyopathy may be similar to those of a heart attack. The symptoms may include:

• Shortness of breath
• Chest pain
• Fatigue
• Arrhythmia or irregular heartbeats
• Cardiogenic shock or reduced pumping of blood out of the heart

How is Takotsubo Cardiomyopathy Diagnosed?

Takotsubo Cardiomyopathy is diagnosed on the basis of the following tests and exams:

• Complete physical examination and assessment of symptoms
• Evaluation of the individual’s stress levels
• Blood tests to check for cardiac markers for heart attack
• Imaging tests of the heart, using techniques, such as X-ray, computed topography (CT) and magnetic resonance imaging (MRI) scan, to check for any abnormality in heart movement
• Electrocardiogram (EKG), which is used to check the heart’s electrical activity
• Echocardiography (ECG): A procedure in which sound waves are used to create a moving picture of the heart, in order to check the size, shape, and pumping function of the heart

Note: A differential diagnosis may typically be required to ensure that the condition is transient and is not a heart attack.

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Takotsubo Cardiomyopathy?

The complications of Takotsubo Cardiomyopathy may include:

• Heart failure owing to cardiogenic shock
• Pulmonary edema or fluid accumulation in the lungs, which can make breathing difficult
• Ventricular free wall rupture, which is a tear in the muscle wall of the ventricles. This condition can be fatal

How is Takotsubo Cardiomyopathy Treated?

The treatment options for Takotsubo Cardiomyopathy may include the following:

• Aspirin, which is used as a blood thinner and to alleviate pain
• Beta blockers and calcium channel blockers, which are generally the first choice of medicines to treat cardiomyopathies, in order to regulate heartbeats
• Diuretics to remove excess fluid and sodium from the body
• Electrolytes to aid in the proper functioning of muscles and nerve tissues
• Anti-coagulants or blood thinners, which prevent blood clot formation
• Bringing about certain lifestyle changes to reduce:
  • Stress (where possible)
  • Smoking
  • Alcohol drinking
  • Lose weight

How can Takotsubo Cardiomyopathy be Prevented?

• Since Takotsubo Cardiomyopathy is triggered by stress, adopting methods of stress management may help prevent the condition
• The condition may be exacerbated by smoking and alcoholism, since a significant proportion of those affected are found to have these habits. Reducing the number of cigarettes smoked and/or alcohol drinks consumed may help avoid TCM
• Routine and regular check-ups with a healthcare professional are highly recommended

What is the Prognosis of Takotsubo Cardiomyopathy? (Outcomes/Resolutions)

• Takotsubo Cardiomyopathy is a transient condition, and most affected individuals recover completely within weeks
• In some cases, however, a heart failure may ensue as a result of TCM

Additional and Relevant Useful Information for Takotsubo Cardiomyopathy:

In the United States, Takotsubo Cardiomyopathy is reported in 0.2% of all hospitalizations that take place.