Takotsubo Cardiomyopathy - Broken Heart Syndrome

Introduction:

Takotsubo cardiomyopathy was first identified in the 1990s in Japan and was named after Japanese octopus traps (takotsubo) that are similar in shape to the heart of the affected individual. Elderly women are the most affected people, but this condition can affect men and younger women. This condition is generally triggered by severe emotional and physical stress. Takotsubo cardiomyopathy is also known as broken heart syndrome, takotsubo syndrome, stress cardiomyopathy, ampulla cardiomyopathy, and apical ballooning syndrome.

What Is Takotsubo Cardiomyopathy?

Takotsubo cardiomyopathy is a condition of the heart characterized by ventricular dysfunction and ballooning. The heart circulates oxygen and nutrients to all the body's organs by pumping blood. The blood vessels carrying the oxygenated blood are known as arteries, and the blood vessel supplying the blood to the heart is called the coronary artery. Patients with takotsubo cardiomyopathy experience an enlargement of a specific portion of the heart, which impairs its ability to pump blood effectively. These patients also encounter temporary blockages in blood flow to the heart. Takotsubo cardiomyopathy is a temporary condition, and the patients recover completely within a month. The symptoms of takotsubo cardiomyopathy are similar to heart attack, but there is no blockage of arteries in patients with takotsubo cardiomyopathy. Though the chances of recurrence are less, it is possible.

What Are the Causes of Takotsubo Cardiomyopathy?

The exact cause of takotsubo cardiomyopathy is still unknown. Numerous theories have been put forward and are currently being investigated. These include:

• Coronary Microvascular Dysfunction - This heart condition specifically impacts the walls and inner lining of the coronary artery.

• Acute Coronary Syndrome With Reperfusion Injury - It is the suddenly reduced blood flow to the heart and tissue injury caused by the blood supply that returns to tissues after a period of lack of oxygen.

• Underlying Coronary Endothelial Dysfunction - The condition in which the large blood vessels on the heart surface constrict (narrow) instead of dilating (opening).

• Impaired Myocardial Fatty Acid Metabolism - It is the decreased metabolism of fatty acids by enzymes.

• Multivessel Coronary Artery Spasm - It is the temporary tightening of the muscles in the wall of the blood vessels that sends blood to the heart.

What Are the Risk Factors for Takotsubo Cardiomyopathy?

The physical or emotional stressor or neurologic injury usually precedes the development of takotsubo cardiomyopathy. These include:

• Legal problems.

• Natural disasters.

• Surgery.

• Use of or withdrawal from the drugs.

• Newly diagnosed with a serious medical condition.

• Bad financial news.

• Motor vehicle collisions.

• Intensive care unit stay.

According to a hypothesis, these stressors cause the release of large amounts of epinephrine (adrenaline) and other stress-related hormones called catecholamines. Elevated levels of these hormones can lead to blood vessel spasms and disturbance in the ventricles. This is responsible for ballooning and ventricular dysfunction.

What Are the Signs and Symptoms of Takotsubo Cardiomyopathy?

The most common signs and symptoms of the condition are:

• Abrupt crushing chest pain.

• Dyspnea (difficulty in breathing).

• Diaphoresis (sweating).

• Transient loss of consciousness (syncope).

• Palpitations.

• Anxiety.

• Nausea.

What Are the Complications of Takotsubo Cardiomyopathy?

Generally, patients with takotsubo cardiomyopathy recover completely within one month, and recurrence is rare. However, complications might occur in about 20% of the patients. Despite the possibility of complications, more than 90% of the patients survive this heart condition. The complications include:

• Heart Failure - The heart is unable to pump blood properly, leading to fatigue, difficulty breathing, and leg and abdominal swelling due to the accumulation of fluid (edema).

• Cardiogenic Shock - Cardiac dysfunction may prevent organs from receiving adequate oxygen supply resulting in cardiogenic shock. This happens in severe cases.

• Cardiac Arrhythmia - It is an irregular, too-fast, or too-slow heartbeat.

• Clot Formation - Due to the pooling of blood in the heart, the possibility of clot formation is increased. These clots can get expelled from the heart and can get lodged into the arteries of the brain leading to a stroke.

• Mitral Regurgitation - It is the backward flow of the blood inside the heart.

• Pulmonary Edema - It is the accumulation of fluids in the lungs.

How to Diagnose Takotsubo Cardiomyopathy?

On experiencing the symptoms, the patient should immediately rush to the nearest emergency room. The physician will inquire about the patient's medical history and recent symptoms. The patient might also undergo a physical examination. The tests recommended by the doctor are:

• Blood Tests - They are done to check for heart damage. It is also done to check for infection, anemia, and other possible symptoms. Increased blood troponin levels are considered a marker of damage to the heart.

• Chest X-ray - This is done to get information about the heart and lungs.

• Cardiac Echocardiogram - It is the medical imaging of the heart using the standard ultrasound or Doppler ultrasound. It is the graphic outline of the heart’s movement. This shows whether the heart is functioning properly and pumping blood efficiently.

• Cardiac MRI (Magnetic Resonance Imaging) - This shows the parts of the heart and how well they are functioning, including how the blood moves. It is a non-invasive assessment of the cardiovascular system. This test helps in diagnosing the condition and assessing the extent of ventricular dysfunction and ballooning.

• Coronary Angiography or Cardiac Catheterization - In this procedure, the heart’s blood vessels are examined using X-ray imaging. This test is done to check for any restriction in blood flow going through the heart or any blood clots in the coronary arteries.

• Electrocardiogram (ECG or EKG) - It is a test used to check the heart’s rhythm and electrical activity. It records the electrical signals from the heart to check for abnormal conditions of the heart.

• Ventriculography - This test is similar to coronary angiography but allows visualization of the ventricles. This helps in the identification of ventricular dysfunction and ballooning.

What Are the Treatment Options for Takotsubo Cardiomyopathy?

Even though there is no standard therapy for the treatment of takotsubo cardiomyopathy, most patients recover completely within one month. The patient may require 24-hour hospital admission. The treatment may include:

• ACE (Angiotensin-Converting-Enzymes) Inhibitors Medication - These help in treating high blood pressure and promote heart recovery.

• Beta-blockers Medication - These medicines decrease the activating effects of catecholamines on the heart and also promote heart recovery.

• Diuretics - These medicines are given to stimulate the production of urine to eliminate excess fluids.

• Vasodilators - These medicines are given to dilate the blood vessels.

• Blood Thinners (Anticoagulants) Medication - These medications are helpful in preventing stroke.

• Oxygen Therapy - This therapy is done to increase the amount of oxygen in the blood.

• Psychotherapy (Talk Therapy) - This is helpful for patients with symptoms like anxiety and stress.

• Intravenous (IV) Fluids - In cases when the doctor feels the patient is dehydrated, intravenous fluids are administered.

Conclusion:

Takotsubo cardiomyopathy is a condition of the heart that is rare to occur, and the patients suffering from it recover within a month. The patients who develop complications also have a good prognosis. 90 % of the patients affected with takotsubo cardiomyopathy are women, and 80 % of them are elderly women suggesting women are at higher risk of developing the condition. The treatment of patients with takotsubo cardiomyopathy is aimed at symptom control and prevention and treatment of complications.