The heart is one of the most important organs in our body, since it allows the cardiovascular system to carry the oxygen and nutrients that each and every organ in the body needs to survive.

However, as with all other organs, the heart can be affected by multiple factors. And we are not only talking about pathogens, but even emotional aspects can influence it and even generate events and heart disease. This is what happens with broken heart syndrome or tako-tsubo myocardiopathy , which we will talk about throughout this article.

Tako-tsubo cardiomyopathy: what is it?

The name Tako-tsubo myocardiopathy or transitory apical dyskinesia refers to a type of coronary pathology characterised by the presence of a temporary dysfunction of the left ventricle , which causes an abnormal heartbeat in the absence of blockage of the arteries or an injury that explains this behaviour.

This is a weakening of the heart muscle, which leads to hypokinesia or akinesia in the most apical parts (at the end of the ventricle the muscle loses some or all of its mobility).

The ventricle in question has a peculiar morphology, with a bulge in the lower part or balloon-shaped tip of the ventricle (another name for it is the transient apical abalone syndrome) that makes it look similar to the traditional Japanese octopus pots that give their name to this disorder (takotsubo).

This temporary alteration is also called broken heart syndrome or stress cardiomyopathy, because a considerable proportion of cases are caused by situations of strong stress or emotional pain, such as those that would result in the death of a loved one, an unexpected break-up, the diagnosis of a disease that is feared or the experience of violence by a partner.

The symptomatology is very similar to that of an acute coronary syndrome or a heart attack : chest pain and heart failure, there is also an increase in cardiac biomarkers and alterations in heart rhythm visible on electrocardiogram. The big difference is that in this case the arteries are not blocked, even though the blood supply may be reduced. This is a pathology that can appear in people of both sexes and at any age, although it is more frequent among women between fifty and seventy years of age.

Although this is usually a temporary disorder that can normalize itself and with a very favorable prognosis, the truth is that although it is not usual , sometimes complications can occur such as (among others) ventricular fibrillation or cardiogenic shock, heart failure, thrombus formation, mitral regurgitation, arrhythmias or rupture of the wall of the ventricle.

Main causes and explanatory hypotheses

Although the causes of tako-tsubo myocardiopathy are not completely known in all cases, requiring further research, some typical causes of this disorder are known .

One of the most validated explanatory theories is that a large number of cases of this disorder can be explained by the presence of elevated levels of catecholamines in the blood (something that has been found in more than 70% of cases), at levels that can be as high as 34 times the usual. We are mainly talking about adrenaline, a hormone that generates excitation and activation of the sympathetic system and therefore generates the activation of the organism.

In turn, this increase is caused in many cases by the experience of severe stress , which can be both emotional (a loss, a scare, unexpected and heartbreaking news…) and physical (which have been located in about 50% of cases, of which about 27% have emotional causes).

Other theories propose the presence of occlusive microvascular spasms as an explanation of this temporary situation, generating a brief ischemia, the presence of an abnormal orientation of the mitral valve that generates an obstruction in the exit of the ventricle or the presence of deficiencies in coronary microvascularization.

Treatment of this pathology

As mentioned above, tako-tsubo myocardiopathy is a transitory disease that usually resolves on its own without leaving any sequelae, with complete recovery in 95% of cases within one or two months . However, when symptoms appear it is essential to go to hospital urgently, since the symptoms are indistinguishable at first sight from other much more dangerous coronary disorders.

As far as treatment is concerned, the solution would generally be to keep the subject hydrated and reduce or eliminate as far as possible any stressors that may have caused the syndrome. It is also possible to administer beta-adrenergic blockers or alpha-adrenergic agonists together with angiotensin-converting enzyme, in order to facilitate blood flow in the acute phase as well as recovery. Also, in case of complications these should be treated differently depending on the type of abnormality that may occur.

Bibliographic references

  • Núñez-Gil, I., Molina, M., Bernardo, E., Ibáñez, B., Ruiz-Mateos, B., García-Rubira, J.C., Vivas, D., Feltes, G., Luaces, M., Alonso, J., Zamorano, J., Macaya, C. and Fernández-Ortiz, A. (2012). Tako-tsubo syndrome and heart failure: long-term follow-up. Spanish Journal of Cardiology, 65 (11): 992-1002.
  • Obón Azuara, B., Ortas NAdal, M.R., Gutiérrez Cía, I. and Villanueva Anadón, B. (2007) Takotsubo cardiomyopathy: transient apical left ventricular dysfunction. Intensive Care Medicine, 31 (3).
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  • Rojas-Jiménez, S. and Lopera-Valle, J.S. (2012), Takotsubo Cardiomyopathy, the great imitator of acute myocardial infarction. CES Med 26(1): 107-120.