Tako-tsubo cardiomyopathy: what is it, symptoms, causes and treatment

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

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

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Tako-tsubo cardiomyopathy: what is it?

It is called with the name of tako-tsubo cardiomyopathy or transient apical dyskinesia to a type of coronary disease characterized by the presence of a temporary left ventricular dysfunction, which happens to have an abnormal heartbeat in the absence of blockage of the arteries or an injury that explains said behavior.

It is a weakening of the heart muscle, which presents hypokinesia or akinesia in the more 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 tip of the ventricle in the shape of a balloon (another of its names is the syndrome of transient apical bulging) that makes it look similar to the traditional Japanese octopus pots that give this disorder its name (takotsubo).

This temporary alteration is also called broken heart syndrome or stress cardiomyopathy, because a considerable proportion of the cases come from the experience of situations of strong stress or emotional pain, such as those that it would cause the death of a loved one, an unexpected breakup, the diagnosis of a feared disease or the experience of intimate partner violence.

The symptoms are very similar to those 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 the heart rhythm visible in the electrocardiogram. The big difference is that in this case the arteries are not blocked, although the blood supply can be reduced. It is a pathology that can appear in people of both sexes and at any age, although it is more common among women between fifty and seventy years of age.

Although we are generally facing a temporary disorder that can become normal by 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 ventricular wall.

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Main causes and explanatory hypotheses

Although the causes of tako-tsubo cardiomyopathy are not completely known in all cases, requiring further investigation in this regard, it is. some typical causes of this alteration are known.

One of the most validated explanatory theories refers to the fact that a large part of the 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 reach 34 times the usual. We are talking mainly about adrenaline, a hormone that generates arousal and activation of the sympathetic system and therefore generates the activation of the organism.

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

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

Treatment of this pathology

As we have mentioned before, tako-tsubo cardiomyopathy is a transient disease that generally ends up resolving on its own without leaving sequelae, existing a complete recovery in 95% of cases in about one or two months. However, when presenting symptoms, it is essential to go urgently to a hospital, since the symptoms are indistinguishable to the naked eye from other coronary disorders much more dangerous.

With regard to treatment, as a general rule the solution would be to keep the subject hydrated and reduce or eliminate as much as possible the possible 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 the Recovery. Likewise, in case of complications, these should be treated differentially depending on the type of anomaly that may occur.

Bibliographic references

• Núñez-Gil, I., Molina, M., Bernardo, E., Ibáñez, B., Ruiz-Mateos, B., García-Rubira, JC, 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. Revista Española de Cardiología, 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 Medicine, 31 (3).
• Rojas-Jiménez, S. and Lopera-Valle, J.S. (2012), Takotsubo cardiomyopathy, the great imitator of acute myocardial infarction. Rev. CES Med 26 (1): 107-120.