Takotsubo Cardiomyopathy (Broken Heart Syndrome)
Takotsubo Cardiomyopathy is a stress cardiomyopathy where there are ECG changes that show a STEMI along with increased troponin levels but there is no occlusion of the artery. Takotsubo is Japanese for a type of trap used to catch an octopus and the reason why this cardiomyopathy is called this, is due to the fact that there is apical ballooning of the left ventricle which looks like the Japanese octopus trap.
The criteria to diagnose Takotsubo Cardiomyopathy include:
1. ECG evidence showing ST elevation or T wave inversions (TWI)
2. Absence of coronary artery disease on angiography
3. Absence of myocarditis
4. Elevated troponin levels
Takotsubo Cardiomyopathy occurs, typically in elderly women, who have had some kind of extremely stressful event. This can include major trauma, loss of a loved one, surgery, extreme fright, or even financial stress. Some symptoms include:
2. Chest Pain
3. Heart Failure
The exact mechanism of Takotsubo Cardiomyopathy is relatively unknown but there are a few theories. The most widespread theory is that it is caused by an influx of catecholamine levels caused by the stressful event. Catecholamines like epinephrine and norepinephrine cause the sympathetic nervous system to kick into overdrive. I want you to think of the most stressful time in your life and remember how your body was reacting to the stress. Your heart rate was increased and your heart was pounding in your chest. When these catecholamines enter your heart, they stimulate the beta-adrenergic receptors to increase the heart rate, inotropy, and can cause vasoconstriction. And as catecholamine levels increase, this can cause your myocardium to become stunned which can lead to left ventricular dysfunction along with microvascular spasms.
Because there is no way to accurately determine if the patient is having a STEMI or has Takotsubo Cardiomyopathy, the best treatment of this is to treat it like a STEMI. An angiogram will show non-obstructive coronary artery disease. Another treatment that is best done after diagnosing Takotsubo Cardiomyopathy is to administer beta blockers due to increased catecholamine levels affecting the beta-adrenergic receptors and treating them as you would a heart failure patient. Another helpful tool is to use an echocardiogram to check for apical ballooning of the left ventricle.
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Khalid, N. (2021, March 3). Pathophysiology of takotsubo syndrome. StatPearls [Internet]. Retrieved February 17, 2022, from https://www.ncbi.nlm.nih.gov/books/NBK538160/
Pelliccia, F., Kaski, J. C., Crea, F., & Camici, P. G. (2017, June 13). Pathophysiology of takotsubo syndrome. Circulation. Retrieved February 17, 2022, from https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.116.027121