Takotsubo (Stress) Cardiomyopathy

+ Author Affiliations

From the Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, MN.

Correspondence to Scott W. Sharkey, MD, Minneapolis Heart Institute Foundation, 920 E 28th St, Ste 300, Minneapolis, MN 55407. E-mail scott.sharkey@allina.com

Introduction

Whenever a new and previously unrecognized medical condition enters our consciousness, considerable confusion and uncertainly can ensue. If a patient is afflicted by such a disease state, the natural reaction is, “I have never heard of what I have,” triggering considerable personal and family anxiety. Such is the case with the condition we now call takotsubo cardiomyopathy, which has received considerable attention from the media and has been assigned a myriad of names in the literature.

Historical Background and Increasing Visibility

Initial recognition of takotsubo cardiomyopathy occurred in Japan in 1990, with the first report emerging from the United States in 1998. Thereafter, scientific interest in this condition has increased steadily and dramatically. For example, in 2000, only 2 publications were recorded, compared with nearly 300 in 2010 (Figure 1). Now, takotsubo is widely recognized, with reports from 6 continents and diverse countries, including France, Belgium, Mexico, Australia, Spain, South Korea, China, Brazil, Germany, Israel, South Africa, Turkey, and Iceland.

View larger version:

Download as PowerPoint Slide

Figure 1.

Increasing number of takotsubo cardiomyopathy publications by year, 2000 to 2010.

What Is Takotsubo?

The Acute Illness

Takotsubo cardiomyopathy starts abruptly and unpredictably, with symptoms of chest pain and, often, shortness of breath, usually triggered by an emotionally or physically stressful event, and with a predilection for women older than 50 years of age (only 10% in men). Most patients go to the emergency department because of concern they are experiencing a heart attack, a much more common acute heart condition caused by a blocked coronary artery (the Table). Although patients with takotsubo do not have significantly narrowed coronary arteries, in the early hours takotsubo and heart attacks share many similarities in presentation, including chest pain and breathlessness, as well as abnormalities in both the electrocardiogram and blood biochemical tests. Even experienced physicians can be challenged to distinguish between the two, at least until an x-ray study of the coronary arteries and left ventricle with dye establishes the absence of severe plaque buildup in a coronary artery as well as the unusual shape of the left ventricle (ie, pumping chamber) that has given takotsubo its unique name (Figure 2).

full-text:
Takotsubo (Stress) Cardiomyopathy