Takotsubo Syndrome

Takotsubo Syndrome, also known as Stress-induced cardiomyopathy, Broken Heart Syndrome and Transient Apical Ballooning Syndrome, is a type of non-ischaemic cardiomyopathy characterized by transient systolic dysfunction of the apical and/or mid-segments of the left ventricle that mimics myocardial infarction. The characteristic apical ballooning shape of the left ventricle resembles a Takotsubo, a type of Japanese octopus trap as seen dangling from a rope in this Daily Doodle. This syndrome is also called “Broken Heart Syndrome” because it can be triggered by intense emotional stress, such as domestic abuse, divorce, death of a loved one, or devastating financial losses. Takotsubo Syndrome is more common in post-menopausal women (F>M).

The pathogenesis is not fully understood, however several mechanisms have been proposed:

  1. Catecholamine excess
  2. Coronary artery spasm
  3. Microvascular Dysfunction

Clinical presentation is similar to an acute MI. Symptoms may include acute substernal chest pain, dyspnea, syncope and shock. ECG abnormalities may include anterior ST segment elevation, deep T-wave inversions with ST interval prolongation and abnormal Q waves. In some cases, ECG appears normal. Myocardial enzymes are often mildly elevated and coronary angiography reveals normal vessels or mild-moderate coronary atherosclerosis. Apical ballooning (shaped like a Takotsubo) is seen on echocardiography or left ventriculography.

Mayo Clinic Diagnostic Criteria for Takotsubo Syndrome includes:

  1. Transient hypokinesis, akinesis or dyskinesis of the left ventricular mid segments with or without apical involvement; the regional wall motion abnormalities typically extend beyond a single epicardial coronary distribution, and a stressful trigger is often, but not always, present
  2. Absence of obstructive coronary disease or angiographic evidence of acute plaque rupture
  3. New electrocardiographic abnormalities (either ST-segment elevation and/or T wave inversion) or modest elevation in cardiac troponin level
  4. Absence of pheochromocytoma or myocarditis

Treatment is similar to that of an MI until diagnosis is confirmed. Since Takotsubo Syndrome is a transient disorder, conservative and supportive treatment with resolution of the triggering stress often results in resolution of symptoms and in many patients, a full recovery is seen within one to two months. Based on their overall clinical condition, patients are usually placed on standard medications for left ventricular systolic dysfunction which include ACE inhibitors, beta blockers and diuretics (if volume overloaded).

 

Sources:

http://www.uptodate.com/contents/stress-induced-takotsubo-cardiomyopathy
http://www.mayoclinic.com/health/broken-heart-syndrome/DS01135

 

 

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