Broken heart syndrome or takotsubo syndrome is a heart muscle disease also called stress cardiomyopathy or ballot tip syndrome. The clinical picture of the broken heart syndrome may be confusingly similar to the acute coronary syndrome. What is the cause of takotsubo syndrome? How is it manifested? Can it be treated?

Stress cardiomyopathy( Broken heart syndrome ,takotsubo syndrome ,Apex balloting syndrome ) is a symptom complex caused by a transient left ventricular systolic dysfunction in the absence of significant atherosclerotic changes in the coronary vessels. It is caused by intense emotional or physical stress.

Takotsubo syndrome was first described by Hikaru Sato et al. In 1990 in Japan. The name tako-tsubo means an octopus vessel. They are characterized by a narrow neck and a voluminous, round bottom. This shape corresponds to the image of this cardiomyopathy in imaging studies.

The data show that approximately 1-2% of initially diagnosed acute coronary syndromes are actually takotsubo syndrome. Most of the cases (as much as 90%) are in postmenopausal women. The average age of occurrence is 67 years.

Stress cardiomyopathy: causes

The etiology of takotsubo syndrome is not fully understood, but the research conducted so far suggests that it is based on impaired function of the coronary microcirculation and the toxic effect of catecholamines on the heart muscle. It is the severe stress (mental and physical) that causes their ejection and the increase in blood concentration that can induce cardiomyopathy. Difficult life situations, e.g. death of a loved one, news of a disease, serious financial problems, natural disasters, accidents may be the triggering stressors. No less important are factors causing physical stress, such as acute abdominal diseases. It is also worth mentioning that the syndrome can also occur without any stress factor.

Takotsubo syndrome: symptoms

Symptoms may very strongly mimic a heart attack or other acute coronary syndromes. The main complaints reported by the patient are:

  • chest pain
  • shortness of breath
  • palpitations
  • nausea and vomiting
  • fainting

Rarely the first manifestation maycardiogenic shock or sudden cardiac arrest.

Broken heart syndrome: diagnosis

The similarity to acute coronary syndromes applies not only to symptomatology, but also to the results of basic diagnostic tests. The most common ECG abnormalities are ST-segment elevation (usually not as pronounced as when the artery is actually occluded), T-wave inversion, and the presence of a Q-wave. All these changes are therefore typical of myocardial ischemia.

In takotsubo cardiomyopathy, there is usually a relatively small and short-term increase in the biomarker of myocardial necrosis - troponins. Laboratory tests also show an increase in the markers of heart failure, i.e. natriuretic peptides - BNP and NT-proBNP. According to some studies, it is the increase in peptides that is more significant in takotsubo syndrome, and the ratio of NT-proBNP to troponins could be used to differentiate it from myocardial infarction without the need for invasive testing.

Imaging tests are, however, decisive for the diagnosis of broken heart syndrome. The cause of haemodynamic changes in stress-induced cardiomyopathy are abnormalities of the myocardial contractility in the left ventricle (less often the right ventricle). The most useful tests for visualizing these changes are echocardiography (ECHO) and ventriculography. In the case of the takotsubo team, we usually deal with the so-called hypokinesis (reduced contractility) or akinesia (lack of contraction) in the middle segments of the left ventricle and apex of the heart, which results in the characteristic image of "tip balling". Based on these studies, we can distinguish several variants of takotsubo cardiomyopathy, however, regardless of the type, abnormal work of the left ventricular muscle causes a decrease in the ejection fraction and may lead to symptoms of heart failure. It is very important for the diagnosis of the disease that the cardiac contractility disorders are of a transient nature.

In clinical practice, the vast majority of patients go to the invasive cardiology unit with the initial diagnosis of acute coronary syndrome for coronary angiography, i.e. coronary angiography. The absence of significant narrowing of the coronary arteries, thrombus or evidence of rupture of the atherosclerotic plaque allows to exclude ACS and, together with other tests, bring us closer to the final diagnosis. The diagnosis criteria also draw attention to the exclusion of other disease states that may manifest themselves in a similar way and should be subject to differential diagnosis, e.g. recent head injury,intracranial bleeding, pheochromocytoma or inflammation of the heart muscle.

Tip Ballot Assembly: Treatment

Treatment of Takotsubo syndrome is symptomatic and usually limited to drug therapy. The main groups of drugs are beta blockers (beta blockers) and angiotensin converting enzyme inhibitors (ACEI). Diuretic therapy is required in the presence of pulmonary edema or congestive heart failure. Impaired contractility of the left ventricle may predispose to the formation of potentially dangerous embolic material. The presence of a thrombus in the heart is an indication for the implementation of anticoagulant therapy. It can also be introduced prophylactically.

Takotsubo syndrome: prognosis

The complications of stress-induced cardiomyopathy are similar to those of a heart attack. They are rare and usually affect the early, acute phase of the disease. These include: acute heart failure with pulmonary edema, acute mitral valve regurgitation, ventricular arrhythmias, cardiogenic shock or rupture of the free heart wall. Mortality is low (approx. 1-3%).

The prognosis for takotsubo cardiomyopathy is very good. As many as 95% of patients regain their full fitness within 4-8 weeks. We are dealing with the return to the correct function of the ventricle. Relapse of the syndrome occurs in only a few percent.

Sources:

1. Rozwodowska M., Łukasiewicz A., Sukiennik A., Świątkiewicz I., Rychter M., Kubica J., Tako-tsubo cardiomyopathy - a clinical problem, [in:] "Folia Cardiologica Excerpta" 2010, vol. 5, no. 5, 298 -304 9 (online)

2. http://emedicine.medscape.com/

Category:

Cardiology