Takotsubo Cardiomyopathy or Broken Heart Syndrome

It is a type of non-ischemic cardiomyopathy, a condition produced when myocardium, the heart muscle, weakens when there is inadequate oxygen supply. It is characterized by the systolic dysfunction of left ventricle in the absence of coronary artery diseases.

Takotsubo cardiomyopathy is frequently triggered by an acute medical illness or excessive stress. It could be emotional or physical stress like the death of a relative, or physical abuse, arguments or financial loss or something unexpected. It is commonly observed in women who have passed menopause.

Since the disease maybe caused by intense emotional stress like the death of a close friend, it is also known as broken heart syndrome.

The other names it is known as are:

  • Transient apical ballooning
  • Apical ballooning cardiomyopathy
  • Stress-induced cardiomyopathy
  • Stress cardiomyopathy

Someone with takotsubo cardiomyopathy would typically suffer from a heart failure with ECG reports suggesting a left ventricular heart attack. During evaluation a left ventricular dysfunction is often noted. If the patient survives this initial stage, the dysfunction will get better in 2 months.

In a typical case, the contractile functions of the left ventricle are depressed, and the movement of the basal walls causes the apex of the heart to bulge out or balloon out with systole. The shape of the resultant left ventricle resembles an octopus trap which is the Japanese name for tako-tsubo. Takotsubo cardiomyopathy was first described in Japan.

What are the Causes of Takotsubo Cardiomyopathy?

A number of theories have been proposed regarding the causes of takotsubo cardiomyopathy.  

  • Wraparound LAD

The LAD (Left Anterior Descending Artery) that supplies blood to the anterior wall of the left ventricle in majority of the patients may wrap around the apex of the heart. Some researchers have found a correlation between takotsubo and this type of LAD that becomes responsible for blood supply to the apex and the inferior wall of the heart.

  • Transient Vasospasm

Yet another theory is that multiple vasospasms or spasms by the arteries may result in temporarily weakening the myocardium. 

  • Microvascular Dysfunction

Among the theories, the most popular is microvascular dysfunction which suggests that there could be dysfunction of the coronary arteries due to which they fail to supply adequate oxygen to the myocardium. 

None of the theories have however been proved true. 

Diagnosis and Treatment

Takotsubo cardiomyopathy may be difficult to diagnose since the ECG findings could be confused for an acute anterior wall heart attack. The treatment of the disease is usually supportive in nature. Heart drugs such as aspirin are observed to have helped even in extreme cases.