Related Subjects:
|Dilated Cardiomyopathy
|Hypertrophic cardiomyopathy (HCM - HOCM)
|Peripartum cardiomyopathy
|Restrictive Cardiomyopathy
|Takotsubo Cardiomyopathy
๐ซ Broken Heart Syndrome (Takotsubo Cardiomyopathy) is a stress-induced, reversible cardiomyopathy.
It mimics ACS with chest pain, dyspnoea, and ECG changes, but lacks significant coronary obstruction.
Most patients recover fully within daysโweeks, but early recognition is crucial to avoid complications.
๐ About
- A retrospective diagnosis โ always manage initially as ACS.
- Characterised by apical ballooning of the LV, giving the โtakotsuboโ shape (Japanese octopus trap).
- Described in 1990 (Japan). Mimics STEMI but angiography shows no obstructive CAD.
- Triggered by severe emotional or physical stress โ hence โbroken heart syndrome.โ
- 90% are post-menopausal women, particularly of Asian or Caucasian origin.
๐งฌ Aetiology
- Likely due to catecholamine surge (adrenaline/noradrenaline โ direct myocardial stunning).
- Microvascular dysfunction and coronary spasm may contribute.
- Triggers: grief, trauma, surgery, infection, financial stress, or extreme exertion.
- Typically no coronary obstruction on angiography.
โ ๏ธ Clinical Features
- Acute chest pain + dyspnoea (mimics MI).
- Can progress to cardiogenic shock, acute heart failure, or pulmonary oedema.
- Arrhythmias: AF, VT, or VF.
- LV thrombus formation or (rarely) free wall rupture.
- Often preceded by emotional or physical stressor.
๐ Differential Diagnosis
- ACS (STEMI/NSTEMI)
- Myocarditis
- Acute heart failure
- Phaeochromocytoma (can mimic Takotsubo)
๐งช Investigations
- ECG: ST elevation, T-wave inversion, QT prolongation, or non-specific changes (STEMI mimic).
- Echocardiography: Apical akinesis + basal hyperkinesis โ โapical ballooning.โ
- Troponin: Mild/moderate rise (lower than STEMI).
- BNP: Often markedly raised.
- Coronary angiography: Normal or non-obstructive coronary arteries.
- Cardiac MRI: Confirms diagnosis; no late gadolinium enhancement (no infarct scar).
- Catecholamines: Often very high compared to STEMI.
๐ Management
- Initial: Treat as ACS (Aspirin, ฮฒ-blocker, ACEi) until Takotsubo is confirmed.
- Supportive: Oโ, diuretics if pulmonary oedema, manage arrhythmias.
- Anticoagulation if LV thrombus or severe LV dysfunction.
- ฮฒ-blockers โ reduce catecholamine effect, esp. if LVOT obstruction.
- ACEi/ARB โ aid LV recovery.
- LV function usually recovers in 1โ4 weeks โ repeat echo to confirm.
๐ Prognosis
- Generally excellent โ complete recovery in most cases.
- 10% recurrence risk; long-term follow-up advised.
- Complications: cardiogenic shock, arrhythmias, LV rupture.
- Psychological support often beneficial (stress trigger link).
๐ References
