Takotsubo cardiomyopathy is also known by several other names such as broken heart syndrome, stress induced cardiomyopathy, transient left ventricular apical ballooning syndrome, Gebrochenes Herz syndrome, etc. This is a type of non-ischemic cardiomyopathy and is caused by sudden temporary weakening of the myocardium. This form of cardiomyopathy is characterized by the transient wall motion abnormalities, which include the apical and mid-portions of the left ventricle. This does not show any type of obstructive coronary disease.
According to a journal published by the American Heart Association, about 85 percent of the Takotsubo cardiomyopathy cases are triggered by emotionally or physically induced stress and symptoms show up within minutes to hours.
The main cause of this particular condition is the severe weakening of the heart muscles triggered by intense emotional or physical stress. The emotional stressors include grief, extreme anger, fear, and relationship conflicts. The physical stressors include acute asthma, stroke, surgery, difficulty breathing, and bleeding, etc.
The Nature Clinical Practice Cardiovascular Medicine associates Takotsubo cardiomyopathy with the increased levels of catecholamine.
As per the published report, although the condition does not feature any flow limiting obstructions in the coronary arteries, the increased levels of cardiac enzymes is the cause of the acute myocardial injury. A significant increase in the levels of plasma catecholamine is reported in the patients, when measured early after the triggering event. The level of catecholamine is found to be 34 times higher than the levels of a normal functioning heart. This surge in the catecholamine levels results in the dysfunction of the cardiac muscles. According to certain studies, the increased catecholamine levels are known to disturb the calcium regulatory system of the myocardium resulting in the dysfunction.
Several other possible causes have also been proposed such as left ventricular outflow tract obstruction, coronary artery vasospasm, and coronary microcirculation dysfunction. However, these have not yet been confirmed and are a part of clinical research.
Chest pain is among the common symptoms in about 50 to 60 percent of the patients. The electrocardiographic abnormalities are the most common finding in case of Takotsubo cardiomyopathy. Transthoracic echocardiography is used for the diagnosis of any mechanical complications. This is also used to visualize apical thrombus, which may develop due to the akinesis of the left ventricular apex. Under these circumstances, anticoagulant therapy is generally prescribed as an instant treatment option and is maintained until complete clot resolution.
The more important tests, namely, the coronary arteriography and left ventriculography are needed to confirm the diagnosis. The apical ballooning of the left ventricles is generally determined by the left ventriculography. Another diagnostic test aims at developing the SPECT-PET images, which evaluate any type of transient ventricular dysfunction. The images also track the metabolic activity within the heart. Other diagnostic techniques such as cardiac magnetic resonance imaging and endomyocardial biopsy may be useful at times.
Reports say that women are more susceptible to Takotsubo cardiomyopathy than men because of the difference in the sex hormones between the two genders. It is also more dominant in the postmenopausal women, which may be related to a deficiency of estrogen.
There is no proven treatment for patients suffering from Takotsubo cardiomyopathy. However, heart failure medications such as beta blockers, ACE inhibitors, and diuretics may be recommended by the clinical experts. Beta blockers may help the patients in reducing the deteriorating effects of catecholamines. In the hemodinamically unstable patients, vasoactive drugs, inotropic agents and intravenous fluid could be administered upon recommendation by the clinicians.
The associated complications with Takotsubo cardiomyopathy such as heart failure may occur in the acute stages, but these are infrequent. With proper health management, most of the patients recover from the condition.
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