TAKOTSUBO SYNDROME
The notion that a broken heart could kill a person was always considered to be a myth. Now that very myth has come to life. Broken heart syndrome or Takotsubo cardiomyopathy is a weakening of the left ventricle (lower chamber) of the heart, usually as a result of severe emotional or physical stress, which could be when your heart is ‘broken’.
Some features of the syndrome include:
Chest pain and shortness of breath after severe stress
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
Some stressors associated with Takotsubo Syndrome:
A sudden drop in blood pressure
Asthma attack
Receiving bad news - like a diagnosis of cancer
Intense fear, arguments or domestic violence
The Cause?
The precise cause isn't known. But some theories suggest that surging stress hormones like adrenaline can ‘’stun’’ the heart triggering changes in heart muscle cells or coronary blood vessels that prevent the left ventricle from contracting efficiently.
Takotsubo Syndrome occurs predominantly in postmenopausal (time after menopause) women soon after exposure to severe emotional or physical stress. For instance, the incidence of Takotsubo Syndrome increased substantially in elderly women living near the epicentre of the Niigata earthquake. More than 90% of the reported cases are in women ages 58 to 75.
A step back
What is the history of this condition and where does it get the term ‘Takotsubo’ from?
This syndrome was first described in 1990, in Japan. They first described this cardiomyopathy as tako-tsubo-like left ventricular dysfunction. The term ‘Takotsubo’ is taken from the Japanese name for an octopus pot which has a unique shape that the left ventricle has come to resemble. The colloquial name ‘Broken Heart Syndrome’ is coined from the feeling of emotional stress and pain when a heart is ‘broken’.
Treatment?
There is no specific medicine or cure to the acute phase of Takotsubo syndrome as cardiac function is normalized within weeks. But when a shock occurs, an intra aortic balloon pump (a cylindrical balloon inserted in the aorta to increase cardiac output) is established as additional support for circulation. To treat the Arrhythmia (irregular heart rhythms) that can sometimes occur, magnesium sulfate is administered. Some research points to estrogen treatment for elderly women, but it has not been clinically administered.
Many animal models are being used to procure more treatments and find the precise cause of this syndrome.
Some Rare Complications:
This syndrome can also be associated with many other heart conditions and can happen after major surgery.
There is a rare case of Takotsubo Cardiomyopathy after 5 months of a heart transplant. This case study highlights the need of including this syndrome in the differential diagnosis of heart-transplanted patients presenting with graft dysfunction. While Takotsubo Cardiomyopathy is usually reversible, it can present with rare complications like systemic embolism, ventricular arrhythmias, cardiogenic shock and cardiac rupture leading to cardiac arrest.
Many of the symptoms can present like a heart attack, so it is important for more information about this syndrome to be available.
Bibliography:
Written by: Svasti Tewari
Edited by: Sakshi Deshpande
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