Broken Heart Syndrome

Takotsubo cardiomyopathy is a rare condition characterized by myocardial infarction–like presentation and left ventricular dysfunction in the absence of coronary artery lesions.

This disease was first identified in Japan in 1990. It is generally benign and shows a full recovery rate of approximately 95%. This pathology is also referred to as stress-induced cardiomyopathy, ampulla cardiomyopathy, or broken heart syndrome.

The condition occurs predominantly in elderly, postmenopausal women and is typically triggered by physical or emotional stress.

Patients often present with symptoms that initially raise suspicion for acute myocardial infarction. Diagnosis is made based on blood test results, ECG, echocardiography, and coronary angiography findings.

Although it may rarely be asymptomatic, it commonly presents with chest pain, dyspnea, and syncope. ECG findings may mimic those of myocardial infarction. Echocardiography typically shows antero-apical akinesia or dyskinesia, which usually resolves completely within days to weeks. Coronary angiography demonstrates no significant coronary artery stenosis.

Although the exact underlying cause is unknown, proposed mechanisms include stress factors, increased adrenergic activity, hypertension, chronic obstructive pulmonary disease (COPD), decreased estrogen levels, microvascular dysfunction, and inadequate myocardial fatty acid metabolism.

In the early stages of the disease, left ventricular function may be compromised due to myocardial injury and typical apical aneurysm formation. Interestingly, these findings usually regress within 2–8 weeks. Treatment is generally supportive, and beta-blocker therapy may be prescribed to prevent recurrence.