Takotsubo cardiomyopathy (broken heart syndrome) is a condition often caused by an episode of severe stress. It can look and feel just like a heart attack. There is heart weakness but without blocked arteries. Heart strength usually returns to normal.
What is Takotsubo?
Takotsubo cardiomyopathy is a weakening of the left ventricle, the heart's main pumping chamber, usually as the result of severe emotional or physical stress, such as a sudden illness, the loss of a loved one, a serious accident, or a natural disaster, such as an earthquake. The condition is also called stress-induced cardiomyopathy or broken heart syndrome.
The main symptoms are chest pain and shortness of breath. Most of the abnormalities in ventricle wall movement resolve in one to four weeks. Most patients recover fully within two months. However, some patients may experience heart failure.
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Causes
The precise cause isn't known, but it is thought surging stress hormones (for example, adrenaline) "stun" the heart, triggering changes in heart muscle cells or coronary blood vessels (or both), that prevent the main pumping chamber of the heart (left ventricle) from contracting effectively.
Broken heart syndrome occurs more often in women than men, especially after menopause.
Diagnosis
Takotsubo symptoms are essentially the same for those of a heart attack. And an electrocardiogram (ECG) may show abnormalities like those found in some heart attacks — in particular, changes known as ST-segment elevation. Other tests are needed to rule out a heart attack.
- Electrocardiogram (ECG): A simple and painless test that measures and records the electrical activity of your heart.
- Coronary angiogram: A dye test used to detect heart problems, such as blockages or narrowed spots. In Takotsubo, there is no evidence on an angiogram of blockages in the coronary arteries. However, blockages are commonly cause for heart attacks.
- Blood tests to measure cardiac biomarkers: In Takotsubo, there can be a rapid but small rise in cardiac biomarkers (substances released into the blood when the heart is damaged). In a heart attack, cardiac biomarkers take longer to rise but peak higher.
- An echocardiogram (ultrasound image): A test that shows abnormal movements in the walls of the left ventricle. In Takotsubo cardiomyopathy, there is a ballooning of the lower part of the left ventricle (apex).
Treatments
There is no standard treatment for broken heart syndrome. It depends on the severity of symptoms, and whether the person has low blood pressure or evidence of fluid backing up into the lungs. Standard heart failure medications, such as beta blockers, ACE inhibitors, and diuretics (water pills), are often recommended.
Resources
- Takotsubo Cardiomyopathy: Information for patients, families and caregivers (PDF)
- Takotsubo Clinic (link to clinic when published)