Written by Dimitrios Vrachatis, Specialist Cardiologist, PhD, National and Kapodistrian University of Athens.
What is stress cardiomyopathy?
Stress cardiomyopathy, also known as broken heart syndrome or Takotsubo cardiomyopathy, is characterised by usually transient dysfunction of the left ventricle. It was first described in Japan in 1990.
What does Takotsubo mean?
Takotsubo is a distinctive type of Japanese pot used to catch octopuses. In stress cardiomyopathy, the appearance of the heart on imaging — ventriculography, echocardiography or cardiac MRI — resembles this pot, which is why the condition takes its name.
Why is it also called broken heart syndrome?
It is also referred to as broken heart syndrome because this cardiomyopathy occurs more often after intense emotional stress.
Is it more common in men or women?
In theory, it can affect either sex. However, stress cardiomyopathy overwhelmingly affects postmenopausal women: 90% of cases are women aged 60–70.
What causes it?
It occurs after intense physical stress, such as an exacerbation of another illness or surgery, or emotional stress, such as a particularly unpleasant or pleasant event.
Although the cause has not been fully established, it appears to be related to increased circulating stress hormones (catecholamines), which affect the myocardium directly and the arterial circulation by increasing afterload — the effort the heart must make to pump blood.
Studies have also shown an increase in stress cardiomyopathy during the COVID-19 pandemic, when physical and emotional stress were greater.
What are the symptoms?
The clinical presentation resembles unstable coronary artery disease, with chest pain, shortness of breath or fainting. It may initially be diagnosed as unstable angina or a heart attack.
Which examinations are needed?
The usual assessment for chest pain is followed: an electrocardiogram, blood markers of myocardial injury and/or an echocardiogram. These tests usually show abnormalities. However, coronary angiography reveals no significant narrowing of the arteries supplying the myocardium.
During the left heart catheterisation needed for coronary angiography, left ventriculography may also be performed: contrast is injected into the left ventricle to show its cavity and reveal the characteristic appearance of the condition.
Is it dangerous?
It used to be considered a benign condition that resolves completely after 4–6 weeks. More recent data indicate that in-hospital mortality is comparable to that of an ischaemic heart attack (approximately 2–7%). In some cases the presentation may be particularly severe, including acute heart failure or shock.
What is the treatment?
Treatment depends on the clinical presentation. In haemodynamically stable patients, who make up most cases, treatment in the acute phase consists of medication and monitoring so that complications can be treated promptly.
In the chronic phase, angiotensin-converting enzyme inhibitors are given for one year. Beta-blockers have been used but probably provide no additional benefit. Recurrences are not considered particularly common.