Takotsubo cardiomyopathy
Formal Definition
Takotsubo cardiomyopathy (also called "stress cardiomyopathy," "broken heart syndrome," or "apical ballooning syndrome") — an acute, reversible cardiomyopathy typically triggered by intense emotional or physical stress (e.g., grief, surprise, severe medical event, surgical procedure, ICU hospitalization) characterized by transient left ventricular systolic dysfunction with a distinctive pattern of apical akinesis and basal hyperkinesis resembling a Japanese octopus-trapping pot (tako-tsubo) on ventriculography or echocardiogram; meets criteria often with elevated troponin and EKG changes mimicking anterior STEMI but typically with unobstructed coronary arteries on angiography.
How It's Used on the Ward
"Broken heart syndrome" or "takotsubo" or "stress cardiomyopathy" — the heart temporarily weakens in response to major emotional/physical stress (death of a loved one, surprise birthday, intense fear); the EKG looks like a STEMI but the cath shows clean coronaries and the ventriculogram shows the distinctive "octopus pot" shape; reversible with supportive care over days to weeks.
Example
""68-year-old woman with no prior cardiac history presents to the ED with acute chest pain and dyspnea 4 hours after learning her grandson was killed in a car accident. EKG: anterior ST elevations in V1-V4. Troponin 4.2. Emergent cath: clean coronaries. Left ventriculogram: classic apical ballooning with hyperkinetic base, EF 30%. Diagnosis: Takotsubo cardiomyopathy from acute emotional stress. Started on ACE inhibitor and beta-blocker. Follow-up echo 4 weeks later: complete recovery of EF to 60%.""
Clinical Context
Diagnostic criteria (InterTAK Diagnostic Score and Mayo Clinic criteria): transient hypokinesis, akinesis, or dyskinesis of LV mid-segments with or without apical involvement; regional wall motion abnormalities extending beyond a single epicardial vascular distribution; frequently a stressful trigger (emotional or physical) but not always present; absence of obstructive CAD or plaque rupture; new ECG abnormalities or modest troponin elevation; absence of pheochromocytoma or myocarditis. Triggers: emotional (grief, fear, anger, surprise — like winning the lottery or being held up at gunpoint), physical (severe illness, surgery, ICU stay, asthma exacerbation). Patient demographics: postmenopausal women predominate (~90%). Complications: LV outflow tract obstruction, cardiogenic shock, ventricular arrhythmias, mural thrombus with embolism, free wall rupture. Treatment: supportive (often resolves in days to weeks), avoid inotropes if LVOT obstruction present, beta-blockade, anticoagulation if apical thrombus. Recovery: EF typically normalizes within 1-4 weeks; recurrence possible.