What is takotsubo (stress) cardiomyopathy (broken heart syndrome)?

Updated: Jul 31, 2019
  • Author: Eric B Tomich, DO; Chief Editor: Erik D Schraga, MD  more...
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Answer

Takotsubo cardiomyopathy, also known as stress cardiomyopathy and "broken heart syndrome," is a sudden, transient cardiac syndrome that involves dramatic left ventricular apical akinesis and mimics acute coronary syndrome (ACS). It was first described in Japan in 1990 by Sato et al.

Patients often present with chest pain, have ST-segment elevation on electrocardiography (ECG), and have elevated cardiac enzyme levels consistent with myocardial infarction (MI). [1] (See the images below.) [2, 3] However, when the patient undergoes cardiac angiography, left ventricular (LV) apical ballooning is present, and there is no significant coronary artery stenosis. (See Presentation and Workup.) [4]

Takotsubo (stress) cardiomyopathy (broken heart syndrome). Electrocardiogram of a patient with takotsubo cardiomyopathy demonstrating ST-segment elevation in the anterior and inferior leads.

Takotsubo (stress) cardiomyopathy (broken heart sy Takotsubo (stress) cardiomyopathy (broken heart syndrome). Electrocardiogram of a patient with takotsubo cardiomyopathy demonstrating ST-segment elevation in the anterior and inferior leads.

Takotsubo (stress) cardiomyopathy (broken heart syndrome). Electrocardiogram (ECG) from the same patient discussed in the previous ECG, obtained several days after the initial presentation. This ECG demonstrates resolution of the ST-segment elevation, and now shows diffuse T-wave inversion and poor R-wave progression.

Takotsubo (stress) cardiomyopathy (broken heart sy Takotsubo (stress) cardiomyopathy (broken heart syndrome). Electrocardiogram (ECG) from the same patient discussed in the previous ECG, obtained several days after the initial presentation. This ECG demonstrates resolution of the ST-segment elevation, and now shows diffuse T-wave inversion and poor R-wave progression.

The Japanese word takotsubo translates to "octopus pot," which refers to the resemblance of the LV shape during systole to this pot on imaging studies. Although the exact etiology of takotsubo cardiomyopathy remains unknown, the syndrome appears to be triggered by a significant emotional or physical stressor. [1, 5] (See Etiology.)


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