What is takotsubo cardiomyopathy?

Takotsubo cardiomyopathy (TCM) is a type of heart condition. It causes sudden chest pain. The symptoms of TCM can look like a heart attack. It is also known as stress induced cardiomyopathy.

Your heart pumps blood containing oxygen and nutrients to all parts of your body. The blood travels through long tubes or vessels called arteries. Oxygen and nutrient-rich blood is also supplied to the heart by smaller blood vessels and its own arteries. These are called the coronary arteries.

In TCM, blood flow to part of the heart is briefly blocked. This might happen if the coronary arteries have a temporary spasm. It might also occur if the smaller blood vessels of the heart don’t get enough blood. Although the symptoms of TCM may feel like a heart attack, the two conditions are different. In a heart attack, a major blockage in one of the coronary arteries triggers symptoms. In TCM, no such blockage is present.

Experts first identified TCM in 1990 in Japan. Since then, it has been found in people all over the world. More people are being diagnosed with it as awareness of the condition has grown.

TCM is somewhat uncommon. The disease most often occurs in older women. But it can happen to men and younger women.

What causes takotsubo cardiomyopathy?

Experts are still trying to understand what causes TCM. Some think it might result from a brief spasm of the coronary arteries. Others think reduced blood flow to the smaller blood vessels of the heart may trigger it. Excess release of stress hormones (adrenaline) may also play a role.

Intense emotions such as grief, fear, or sadness may trigger TCM. That’s why the condition is sometimes called broken heart syndrome. A sudden illness may also precede it. TCM might be triggered by:

  • Accidental overdose of adrenaline
  • Adrenaline-producing tumor
  • Asthma flare
  • Chemotherapy
  • Death of a relative
  • Domestic abuse
  • Major financial loss
  • Natural disasters
  • Surgery

In some cases, there is no obvious cause for TCM.

What are the risks for takotsubo cardiomyopathy?

You may have a higher risk for TCM if one of your family members had it. Having an anxiety disorder also seems to raise a person’s risk. Traditional risk factors for a heart attack, such as smoking, do not make you more prone to TCM.

What are the symptoms of takotsubo cardiomyopathy?

Symptoms of TCM may look like a heart attack. During an episode, you might experience:

  • Fainting
  • Pale skin
  • Shortness of breath
  • Sudden, sharp chest pain (most common symptom)

How is takotsubo cardiomyopathy diagnosed?

If you have symptoms, such as chest pain, call 911 or go to nearest ER. There, you’ll likely be asked about your medical history, including recent symptoms. You may also have a physical exam. A healthcare provider will look at your heart and lungs.

You may also need additional tests, such as:

  • A chest X-ray to get information about your heart and lungs
  • A series of blood tests for heart damage
  • Basic blood work to test for anemia, infection, and other possible causes of your symptoms
  • Cardiac echocardiogram to see how well your heart is pumping
  • Cardiac MRI if the diagnosis is still in doubt
  • Coronary angiography or cardiac catheterization to see if you have a blood clot in your coronary arteries
  • ECG or EKG to look for signs of heart rhythm problems

In the early stages, it may be hard for your healthcare provider to tell TCM from a heart attack. The symptoms and early test results are often quite similar. Both the ECG and cardiac blood markers may look like those found when a person has a heart attack.

An imaging test of the coronary arteries can help detect TCM. The test will show no blockage. TCM also usually has a specific pattern of heart movement. It can be seen with an echocardiogram.

How is takotsubo cardiomyopathy treated?

You may need to stay in the intensive care unit (ICU) for at least 24 hours. Treatment might include:

  • ACE inhibitor drugs also to promote heart recovery
  • Beta-blocker drugs to help promote heart recovery
  • Blood thinner medicines (anticoagulants) to help prevent stroke
  • IV fluids if your doctor suspects dehydration
  • Oxygen therapy to increase oxygen in your blood
  • Psychological therapy to address problems like anxiety and stress
  • Treatment of a triggering medical condition (like asthma)

At first, you might also be treated for a heart attack. For instance, you may be given aspirin. This treatment may last until your healthcare provider determines your symptoms aren’t caused by a heart attack.

Most people with TCM survive if they are properly treated. An episode of TCM usually damages your heart only for a short time. Within a few weeks, the heart pumps normally with its full force.

Although most people don’t have another episode of TCM, there is a risk of recurrent episodes.

What are the complications of takotsubo cardiomyopathy?

The symptoms of TCM often go away without any problems. Uncommonly, the following complications might happen:

  • Back-up of fluid into the lungs (pulmonary edema)
  • Backward flow of blood inside the heart (mitral regurgitation)
  • Heart failure which causes reduced blood flow to vital organs
  • Irregular heart rhythms
  • Stroke from formation of a clot inside the heart

When should I call my health care provider?

If you have sudden severe chest pain or another sign of TCM, go to the ER or call 911.

Key points

  • TCM is a condition that can look like a heart attack. It usually does not cause lasting heart damage.
  • TCM results from a sudden and short-term drop in blood flow to part of the heart. Unlike a heart attack, it is not caused by a blockage in a coronary artery.
  • Sudden emotional stress can trigger TCM. So can a physical illness.
  • At first, your healthcare provider may have a hard time telling TCM from a heart attack.
  • You may need to take medicine to treat the symptoms of TCM.
  • TCM may cause major complications, like heart failure. It rarely leads to death.
  • Most people who have an episode of TCM do not need long-term treatment. Most never have future episode.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your healthcare provider tells you.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
  • Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
  • Ask if your condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if you do not take the medicine or have the test or procedure.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your healthcare provider if you have questions.

Saint Luke's Cardiovascular Consultants

A leader in cardiac care, Saint Luke’s Cardiovascular Consultants treats patients throughout the Kansas City area and surrounding communities. Our medical team consists of both board-certified clinical cardiologists as well as physicians certified in specialty areas of cardiology including interventional cardiology, echocardiography, nuclear cardiology, preventive cardiology, and electrophysiology.