Takotsubo Cardiomyopathy/Broken Heart Syndrome

By Emma Spence, MEDS '21

While we may not be able to physically “laugh our head off” or “cry our eyes out,” can someone really “die of a broken heart?” Perhaps the answer is yes. 

Broken Heart Syndrome, or more formally Takotsubo Cardiomyopathy, is described as transient dysfunction of the left ventricle (LV) in the absence of significant coronary artery disease. On echo, the resulting regional myocardial dysfunction leads to a systolic ballooning appearance of the LV apex. The etymology of the term “Takotsubo” stems from a Japanese pot used as an octopus trap, the shape of which is similar to the echocardiographic or radiographic appearance of the LV abnormality in the most typical form of the condition.

But how did this disease earn its melancholic alias? Well, while there remains uncertainty as to the exact etiology and pathogenesis of this phenomenon, emotionally stressful events such as a traumatic break-up or unexpected sudden loss of a loved one are commonly associated triggers. 

The presenting symptom is most often retrosternal chest pain, but patients can present with dyspnea or syncope. Symptoms of heart failure may also ensue. Auscultation may reveal new murmurs pointing toward acute mitral regurgitation or dynamic LV outflow tract obstruction. Cardiac biomarkers and ECG findings are often similar to STEMI with elevated troponins, ST elevation, T wave inversion and abnormal Q waves. However, angiography will not show significant obstructive coronary artery disease or acute plaque rupture (though it is possible to have co-morbid CAD that may or may not be contributing to the presentation). Ventriculography or echo will demonstrate the LV wall abnormality (the octopus trap), and the latter is performed in serial fashion to follow along for resolution.
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Given that stress cardiomyopathy and its complications can be life threatening, perhaps we really can die of a broken heart. However, the events themselves do tend to be transient, meaning that perhaps our mothers are, as always, right – only time can mend a broken heart.

Sources:
UpToDate. Reeder, G.S., Prasad, A. Clinical manifestations and diagnosis of stress (Takotsubo) Cardiomyopathy. In: UpToDate, Post, TW (ed), UpToDate, Watham, MA, 2019
DynaMed. Takotsubo Syndrome. In: DynaMed, Ipswich, MA, updated Nov 30, 2018