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As the symptoms of takotsubo cardiomyopathy mimic a heart attack, it must never be confused with or self-diagnosed as broken heart syndrome.
Takotsubo cardiomyopathy is a reversible disease of the heart muscle that is suddenly weakened or stunned following a physical or an emotional event. In this condition, a part of the heart enlarges and does not pump as well as the rest of the heart. Often it is the lower or bottom end of the heart (apex). This part of the heart's left ventricle gets bigger, which leads to ineffective pumping of blood and, hence, it is also called 'apical ballooning syndrome'.
Takotsubo cardiomyopathy was first described in Japan in 1990. The name comes from the Japanese word for a pot with a narrow neck and a wide round bottom used by fishermen to trap octopi. The distinctive shape of the left ventricle looks like a takotsubo pot on ventriculogram (imaging study of the heart chambers) and hence the name.
This disease mostly affects women (about 88 per cent), especially in later middle age (after menopause; mean age range 50 to 74). One possible explanation is that the female hormone estrogen protects the heart against any harmful effects of hormones released in response to stress. As the level of estrogen declines with age, women might be more susceptible to the effects of sudden stress. Research has clarified that women between 50 to 74 years of age are disproportionately at higher risk for takotsubo cardiomyopathy.
Takotsubo cardiomyopathy is an enigmatic disease with a multifactorial and still unresolved pathogenesis. The precise cause isn't known, but experts think that surging stress hormones (for example, adrenaline) essentially "stun" the heart, triggering changes in heart muscle cells or the heart's blood vessels (or both) that prevent the left ventricle from contracting effectively. Some of the common causes are
Common emotional triggers for takotsubo cardiomyopathy are the death of a loved one or a pet, a serious accident, a fierce argument, post-traumatic stress disorder, a job loss or a sudden illness. These triggers are the reason for its clinical titles, "broken heart syndrome"; "stress cardiomyopathy".
There is no evidence to suggest that takotsubo cardiomyopathy can be hereditary. Most of the patients who have had takotsubo cardiomyopathy are unlikely to have a repeat episode again. Recurrence is never observed. It is more common in the summer months; the chronobiologic pattern is the opposite of that observed for heart attack which occurs more in the winter season.
The symptoms of takotsubo cardiomyopathy can look like a heart attack. Sudden sharp chest pain is the most common symptom, shortness of breath, palpitations or awareness of one's own heartbeat and fainting. In the early stages, it may be hard to differentiate takotsubo cardiomyopathy from a heart attack. The symptoms and early test results are often a lot alike.
Diagnosis of takotsubo cardiomyopathy requires the following tests:
As the symptoms of takotsubo cardiomyopathy mimic a heart attack, it must never be confused with or self-diagnosed as broken heart syndrome.
Treatment includes medication to strengthen the heart muscle and improve pumping called beta-blockers, ACE inhibitors and blood thinners. The stunning heart muscle usually heals within 2-4 weeks, and most patients recover fully within two months. It is imperative to manage any physical or emotional stress that may have triggered the condition with anti-anxiety medications, stress management and cardiac rehabilitation. Regular follow-ups with echocardiograms to check the heart's recovery is advised.
Complications of takotsubo cardiomyopathy can be fatal. However, death is an extremely rare event (less than 1 per cent). Some of the complications are
There are no known treatments for preventing broken heart syndrome. However, learning stress management and problem-solving techniques can help improve physical and emotional stress. Engaging in relaxation techniques like practicing yoga, meditation, journaling, mindfulness or breathing exercises. Depending on the source of stress, there may be a support group one can join to talk about the stress and share coping skills with others who have had similar experiences. Seeking the help of a professional counsellor might be considered too. In addition, managing physical or emotional stress can be helped by following general healthy habits like a healthy diet, exercise, good sleep, avoiding smoking, consumption of alcohol and illicit drug use, keeping up with medical appointments for both follow-up and preventive health screenings.
Takotsubo cardiomyopathy is a rare disease, however, it is on a rise across the world, in women more than men. The upswing in cases could be due to changes in susceptibility, the environment or both. It is now known in the women dominated conditions, the vital role the heart-brain connection plays in overall health, especially for women.
(This article is authored by Dr Darshana Reddy, Senior Consultant - Internal Medicine, Altius Hospital, Bangalore)