Takotsubo Syndrome

What is Takotsubo Syndrome?

Takotsubo syndrome is left ventricular dysfunction of the heart and occurs due to excessive stress. Alternatively, Takotsubo syndrome also known as stress cardiomyopathy or broken heart syndrome. The onset of this cardiac condition is acute and similar as a heart attack. But usually the condition is not long lasting and after certain period condition becomes reversible^1,2.

History

Takotsubo syndrome is not a very old disease, as it is first reported in 1990 in Japan. In Japanese, the meaning of ’Takotsubo’ is ‘octopus pot’. The syndrome is named so due to the shape of the left ventricle changed to a narrow neck and a round bottomed pot⁴.

Predominance

The incidence of the Takotsubo syndrome can occur at any age but reported incidence described 58 to 75 years age group patients are affected mostly. The condition typically abounds to women than men. It has been assumed that 5% of total reported case of heart attack, specifically in women is actually Takotsubo syndrome, as both the conditions have a similar type of symptoms^3,4.

Pathophysiology

Stress induces Takotsubo syndrome. The left ventricle is the main pumping chamber of the heart and due to sudden physical stress or emotional incidence influence to narrowing the chamber and weakening of the left ventricle causes disturbance of the blood circulation. Cardiomyopathy causes disturbance of the pumping of the chamber^2,4.

Causes

The exact cause of the development of the Takotsubo syndrome is unknown. Stress increase the release of adrenaline hormone and that may cause temporary cardiomyopathy in some individual. It is assumed that association of temporary construction of the large or small coronary arteries also responsible for initiating the condition. Certain triggering factors may positively influence Takotsubo syndrome^3,4,6.

Triggering factors

• Blood pressure dropping
• Cardiac stress enhancement due to serious ailments, surgical intervention, prolonged medical procedure
• Extreme pain
• Conjugal hostility
• Bronchial spasm due to asthma attack
• Setback due to hearing of shocking news
• Vehicle accident
• Death news of relatives or other close ones
• Aggressive argument
• Economic impede
• Extreme panic
• Public speaking⁵

Risk factors

Some risk factors are considered to promote Takotsubo syndrome, which include

Gender

Women are more susceptible than men and incidence rate is more in women.

Age

The risk of Takotsubo syndrome is increasing with age or after fifth decades of life, most of the incidence occurs.

Medical history of neurological condition

Association of neurological disorders like central nervous system injury, the epileptic disorder causes a higher risk of Takotsubo syndrome.

Association of psychiatric disorder

The tendency of depression or anxiety increase the stress level and that may cause increase risk of Takotsubo syndrome^4,5.

Symptoms

The symptoms of Takotsubo syndrome are same as heart attack, which includes Chest pain, shortness of breathing⁴.

Complications

Takotsubo syndrome is reversible and temporary medical event, therefore it usually does not cause a fatal outcome. Patient recovery is fast and not provide any prolonged health effect. Following are the possible complications may associate with Takotsubo syndrome.

• Fluid accumulation in the lungs or pulmonary edema
• Hypotension or low blood pressure
• Heart-beat disruption
• Heart attack
• Tendency to reoccur the attack at stressful condition^3,4

Diagnosis

The following are some tests useful for diagnosis of Takotsubo Syndrome.

Physical examination

Thorough physical examination and vital sign checking are important for the determination of the patient condition and after that following laboratory-based testing are identified.

ECG

In ECG test, the electrical signal passage is measured and the onset of Takotsubo Syndrome shows irregularities of heart rhythm.

Echocardiogram

An echocardiogram also performs to check the enlargement of the heart. This is a non-invasive imaging tool, which provides detail structural and functional description. In this diagnostic medical device, ultrasound waves are transmitted and produce transducer at the exterior of the body. This transducer creates images on the computer screen.

Hematological test

Certain enzymes are elevated in the blood in Takotsubo Syndrome and the hematological test can identify the level of those enzymes.

Chest X-ray

Chest X-ray helps to exclude the involvement of the lungs disorder, whereas X-ray image assists in detecting enlargement of the heart. Enlargement of the heart is a typical sign of Takotsubo Syndrome.

Cardiac MRI

In this test magnetic field is produced by the body and that can create detailed internal body images. The doctor can evaluate those picture to detect the cause of the symptoms.

Coronary angiogram

In this test dye in inserted into the coronary blood vessels and through X-ray, machine dye is visible. This method is called angiogram and detailed images of coronary blood vessels can possible by performing this test.

There is no blockage of coronary blood vessels identified in angiogram test in Takotsubo Syndrome, but blockage is prominent in a heart attack. This is the main difference and that can be identified through an angiogram^2,6.

Treatment

There is no specific treatment for Takotsubo Syndrome, but provided treatment is very similar to heart attack due to immediate discrimination is not possible.

Usually, the patient is under observation in the hospital during recovery period.

Doctor prescribes different cardiac medicine like ACE (angiotensin-converting enzyme) inhibitors, beta blockers or diuretics to reduce the cardiac workload after confirmation of the Takotsubo Syndrome through angiography . Usual time of recovery occurs within one month and medications require to continue for a period of three to six months.

No surgical intervention including angioplasty and stent placement need not require for treating Takotsubo Syndrome⁶.

References

1. Maron BJ, Towbin JA, Thiene G, et al. Contemporary Definitions And Classification Of The Cardiomyopathies: An American Heart Association Scientific Statement From The Council On Clinical Cardiology, Heart Failure And Transplantation Committee; Quality Of Care And Outcomes Research And Functional Genomics And Translational Biology Interdisciplinary Working Groups; And Council On Epidemiology And Prevention. Circulation. 2006;113:1807–16.
2. Ana María Castillo Rivera, Manuel Ruiz-Bailén, Luis Rucabado Aguilar; Takotsubo cardiomyopathy – a clinical review; Med Sci Monit. 2011; 17(6): RA135–RA147. Published online 2010 Aug 27. doi: 10.12659/MSM.881800
3. Takotsubo cardiomyopathy; British Heart Foundation; Online available at https://www.bhf.org.uk/heart-health/conditions/cardiomyopathy/takotsubo-cardiomyopathy
4. Takotsubo cardiomyopathy (broken-heart syndrome); Harvard Health Publications; Online available at http://www.health.harvard.edu/heart-health/takotsubo-cardiomyopathy-broken-heart-syndrome
5. Takotsubo Cardiomyopathy; Medscape; Online available at http://emedicine.medscape.com/article/1513631-overview;
6. Mayo Clinic Staff; Broken heart syndrome; Online available at http://www.mayoclinic.org/diseases-conditions/broken-heart-syndrome/diagnosis-treatment/treatment/txc-20264226