Working as a medical assistant in a heart and vascular clinic I have seen many instances of heart failure. These often involve the heart being overworked or blockages in the coronary arteries. In such instances we are able to diagnose the cause and treat the underlying condition. Every now and then though, we see an instance of Takotsubo cardiomyopathy which is also known as Broken Heart Syndrome. Takotsubo cardiomyopathy is strange in that it is hard to diagnose for certain but one thing that most cases have in common is that ventriculograms of the heart have a very distinctive vase like shape with a round bottom and a narrow neck. A Takotsubo is an instrument used for catching octopuses which looks very similar to a vase (Akashi et. al., 2008).
Takotsubo is an acute form of cardiomyopathy or heart failure that is caused directly by stress. It occurs predominantly in post-menopausal women after sudden exposure to a large stress whether physical or mental. As you can probably guess this stress is usually caused by the death of a loved one but it can also be caused by abuse, high work load or even extreme disasters. The amount of cases of Takotsubo substantially increased after the Niigata Earthquake in elderly women (Sato et. al., 2006). The good news is that this is not a permanent form of heart failure. As a matter of fact in most cases it will reverse itself after a couple weeks, meaning if the person is being treated for heart failure with appropriate precaution they should go back to living a full life (Akashi et. al., 2008). Now for the bad news, any person who has experienced this stress induced heart failure is likely to develop this again. When discussing with patients about Takotsubo especially close to the time of the incident, the doctors I work with suggest avoiding places that may cause the recurrence of symptoms. This raises a conundrum as many patients are unable to avoid these areas whether it is the house of loved one or a favorite spot. How can we make it so that the patient can continue with their life yet also not end up back in the hospital? Some doctors leave these patients on heart failure medications indefinitely until much more time has passed than needed but medications can get expensive and insurances don't like to pay if they don't have to. I digress discussions about the difficulty of insurance is a talk for another time and probably a different class.
References:
Akashi YJ, Goldstein DS, Barbaro G, Ueyama T. Takotsubo cardiomyopathy: a new form of acute, reversible heart failure.Circulation. 2008; 118:2754–2762. doi: 10.1161/CirculationAHA.108.767012
Sato M, Fujita S, Saito A, Ikeda Y, Kitazawa H, Takahashi M, Ishiguro J, Okabe M, Nakamura Y, Nagai T, Watanabe H, Kodama M, Aizawa Y. Increased incidence of transient left ventricular apical ballooning (so-called “Takotsubo” cardiomyopathy) after the mid-Niigata Prefecture earthquake. Circ J. 2006; 70: 947–953.
This is horribly sad, but also fascinating. I’ve heard so many times how you can die of a broken heart but never knew that this disease was named and can be diagnosed. I was curious and interested in the epidemiology of the disease and so I looked into it. Turns out, it is underestimated because there is such an unawareness of the disease (Y-Hassen et al., 2018). With increasing awareness and the recognition of it on ventriculograms, studies are showing significant increases in hospitalizations due to the disease (Y-Hassen et al., 2018). Studies from other parts of the world are showing that 85-90% of patients with Takotsubo Cardiomyopathy are women aged 65-70 years of age which are significant statistics (Y-Hassen et al., 2018). That is so many more women being affected by it than men.
ReplyDeleteInterestingly enough, I just wrote a post regarding hypertrophic cardiomyopathy and from images of Takotsubo Cardiomyopathy, it almost seems as if this is the opposite. It looks as if the ventricle walls are hypotrophic instead, but lead to similar symptoms and problems.
Y-Hassan, S., & Tornvall, P. (2018). Epidemiology, pathogenesis, and management of takotsubo syndrome. Clinical autonomic research : official journal of the Clinical Autonomic Research Society, 28(1), 53–65. https://doi.org/10.1007/s10286-017-0465-z