Takotsubo: Understanding Broken Heart Syndrome

Summary
Takotsubo cardiomyopathy, or Broken Heart Syndrome, is a unique condition that mimics a heart attack but differs in etiology and treatment. Named after the Japanese octopus trap that resembles the left ventricle’s shape in this condition, Takotsubo predominantly affects older women and is often triggered by emotional or physical stress.

• Epidemiology
  • Occurs in 1-3% of suspected STEMIs.
  • Predominantly affects women over 50, with most cases reported in Caucasians.
• Mechanisms
  • Associated with catecholamine excess, microvascular dysfunction, coronary artery spasm, and triggers from emotional or physical stress.
• Clinical Presentation
  • Common symptoms include acute chest pain, dyspnea, syncope, and signs of heart failure.
• Diagnosis & Imaging
  • Diagnosis often relies on the Mayo Clinic Criteria:
    • Transient LV dysfunction.
    • Absence of obstructive CAD.
    • EKG/biomarker changes.
    • No pheochromocytoma or myocarditis.
  • Imaging includes serial echos and CMR, with PET showing potential metabolic mismatches.
• Treatment
  • Supportive, with routine heart failure management and anticoagulation if a large hypokinetic area is present.

Created by: Dr. Dinu Balanescu
Edited by: Dr. Evelyn Song

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