Takotsubo Cardiomyopathy

What is takotsubo cardiomyopathy?

Takotsubo cardiomyopathy (TCM) is generally a short-term (temporary) type of heart condition. It can be triggered by an intense emotional or physical stress. It causes sudden chest pain or shortness of breath. The symptoms of TCM can look like a heart attack. It's also called stress-induced cardiomyopathy, and broken heart syndrome. With TCM, a part of the heart enlarges and doesn't pump as well as the rest of the heart. Often it's the left lower or bottom end of the heart (apex). This part of the heart's left ventricle gets bigger and then can't pump blood normally. TCM is also called apical ballooning syndrome.

Your heart pumps blood containing oxygen and nutrients to all parts of your body. The blood travels through long tubes or vessels called arteries. Oxygen-rich and nutrient-rich blood is also supplied to the heart by smaller blood vessels and its own arteries. These are called the coronary arteries.

In TCM, blood flow to part of the heart is blocked for a short time. This might happen if the coronary arteries have a temporary spasm. It might also occur if the heart's smaller blood vessels don’t get enough blood. The symptoms of TCM may feel like a heart attack. But the 2 conditions are different. In a heart attack, a major blockage in 1 of the coronary arteries triggers symptoms. In TCM, there's no such blockage.

Experts first identified TCM in 1990 in Japan. Since then, it's been found in people all over the world. More people are being diagnosed with it as awareness of the condition has grown.

TCM is uncommon. The disease most often occurs in older women. But it can happen to men and younger women.

What causes takotsubo cardiomyopathy?

Experts are still trying to understand what causes TCM. Some think it might result from a brief spasm of the coronary arteries. Others think reduced blood flow to the smaller blood vessels of the heart may trigger it. Excess release of stress hormones (adrenaline) may also play a role .

Intense feelings such as grief, fear, or sadness may trigger TCM. That’s why the condition is sometimes called broken heart syndrome. A sudden illness may also occur just before it happens. TCM might be triggered by:

• Accidental overdose of adrenaline

• Adrenaline-producing tumor

• Asthma flare

• Chemotherapy

• Death of a relative

• Domestic abuse

• Major financial loss

• Natural disasters

• Surgery

In some cases, there's no clear cause for TCM.

Who is at risk for takotsubo cardiomyopathy?

You may have a higher risk for TCM if one of your family members had it. Having an anxiety disorder also seems to raise a person’s risk. Traditional risk factors for a heart attack, such as smoking, don't make you more likely to have TCM.

What are the symptoms of takotsubo cardiomyopathy?

Symptoms of TCM may look like a heart attack. During an episode, you might have:

• Sudden, sharp chest pain (most common symptom)

• Shortness of breath

• Fainting

How is takotsubo cardiomyopathy diagnosed?

If you have symptoms, such as chest pain, call 911. You'll be taken to the nearest emergency room. There you’ll likely be asked about your health history, including recent symptoms. You may also have a physical exam. A healthcare provider will look at your heart and lungs.

You may also need other tests, such as:

• Chest X-ray. This can give information about your heart and lungs.

• Blood tests. These are done to check for heart damage.

• Basic blood work. This is done to test for anemia, infection, and other possible causes of your symptoms.

• Cardiac echocardiogram. This can show how well your heart is pumping.

• Cardiac MRI. This imaging test is done if the diagnosis is still not certain.

• Coronary angiography or cardiac catheterization. This is to see if you have a blood clot in your coronary arteries.

• Electrocardiogram (ECG). This is to look for signs of heart rhythm problems.

In the early stages, it may be hard for your healthcare provider to tell TCM from a heart attack. The symptoms and early test results are often a lot alike. Both the ECG and cardiac blood markers may look like those found when a person has a heart attack.

An imaging test of the coronary arteries can help find TCM. The test will show no blockage. TCM also often has a certain pattern of heart movement. It can be seen with an echocardiogram.

How is takotsubo cardiomyopathy treated?

You may need to stay in the hospital for at least 24 hours. Treatment might include:

• ACE inhibitor medicines. These can help promote heart recovery.

• Beta-blocker medicines. These can also help promote heart recovery.

• Blood-thinner medicines (anticoagulants). These can help prevent stroke.

• IV (intravenous) fluids. This may be used if your healthcare provider thinks you may be dehydrated.

• Oxygen therapy. This is done to increase oxygen in your blood.

• Talk therapy (psychotherapy). This can help with problems such as anxiety and stress.

• Treatment of a triggering health condition. These can include conditions such as asthma.

At first, you might also be treated for a heart attack. For instance, you may be given aspirin. This treatment may last until your healthcare provider determines your symptoms aren’t caused by a heart attack.

Most people with TCM survive if they are correctly treated. An episode of TCM often damages your heart only for a short time. In a few weeks, the heart pumps normally with its full force.

Most people don’t have another episode of TCM. But there is a risk of other episodes.

What are possible complications of takotsubo cardiomyopathy?

The symptoms of TCM often go away without any problems. But in some cases the following complications might happen:

• Fluid backup into the lungs (pulmonary edema)

• Backward flow of blood inside the heart (mitral regurgitation)

• Heart failure which causes reduced blood flow to vital organs

• Cardiogenic shock with low blood pressure

• Irregular heart rhythms

• Stroke from a clot forming inside the heart

When should I call my healthcare provider?

Call 911 if you have sudden severe chest pain or another sign of TCM.

Key points about takotsubo cardiomyopathy

• TCM is a condition that can look like a heart attack. It often does not cause lasting heart damage.

• It results from a sudden and short-term drop in blood flow to part of the heart.

• Sudden emotional stress can trigger TCM. So can a physical illness.

• At first, your healthcare provider may have a hard time telling TCM from a heart attack.

• You may need to take medicine to treat the symptoms. TCM may cause major complications, such as heart failure or shock.

• Most people who have an episode of TCM don't need long-term treatment. Most never have a repeat episode.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.

• Before your visit, write down questions you want answered.

• Bring someone with you to help you ask questions and remember what your healthcare provider tells you.

• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.

• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.

• Ask if your condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if you do not take the medicine or have the test or procedure.

• If you have a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your healthcare provider if you have questions.