What is takotsubo syndrome?

Dr Dana Dawson

It's sometimes called broken heart syndrome, and it's still a little-known condition. Senior Cardiac Nurse Emily Reeve learns more from Dr Dana Dawson, Reader in Cardiovascular Medicine at the University of Aberdeen. 

Takotsubo syndrome is a sudden and acute form of heart failure. Symptoms can be similar to a heart attack. It is also known as takotsubo cardiomyopathy, broken heart syndrome, acute stress induced cardiomyopathy, and apical ballooning. The heart muscle becomes suddenly weakened or ‘stunned’ and the left ventricle, one of the heart’s chambers, changes shape. This affects the heart’s ability to pump blood.

It’s difficult to put a figure on how many people are affected, because it’s only been widely recognised in the last few years. It’s thought of as being rare, though our data suggests it could represent six to seven per cent of all presumed heart attacks admitted through a cardiology department. Most people recover, but a small minority of cases (about four per cent) die in hospital.

The condition was first identified in Japan in 1990. The term ‘takotsubo’ is taken from the Japanese name for an octopus pot, which has a unique shape that the left ventricle comes to resemble.

What are the symptoms?

Initial symptoms of takotsubo syndrome are similar to those of a heart attack – chest pain, breathlessness or collapse. Call 999 immediately if you or someone you’re with experiences these symptoms.

What causes it?

Takotsubo syndrome usually occurs in people who have experienced intense emotional or physical stress

Takotsubo syndrome usually occurs in people who have experienced intense emotional or physical stress. But in some cases there is no identifiable trigger. Exactly what causes it is currently a scientific mystery. Researchers are trying to understand the interaction between the heart muscle and emotional signals in the brain. One theory is that exposure to an emotionally traumatic event causes a surge of adrenaline at levels that are harmful to the heart.

We don’t have a definitive answer yet though.

MRI scan showing Takotsubo syndrome

Cardiac MRI images showing cross-sections of the heart, comparing a normal healthy heart with two other hearts affected by Takotsubo syndrome. Green colour is normal heart muscle, red indicates water retention/swelling of the heart muscle.

How is takotsubo syndrome diagnosed?

Initially, patients will have an electrocardiogram (ECG) and blood tests. These will appear to show that they had a heart attack. But when doctors examine the heart arteries, there will be no evidence of blockage as there would be after a heart attack. Instead, doctors will see that the heart muscle is not working properly, and the bottom left chamber of the heart (the left ventricle) is larger than normal. The cardiologist should then ask the patient about any recent event that may have triggered the acute attack.

This can be anything perceived as intensely emotional or physically traumatic to that individual.

How is it treated?

There is no medicine known to help in the acute phase of takotsubo syndrome, or to prevent a second episode. Because heart attacks must be treated quickly to reduce damage to the heart, takotsubo syndrome is often treated as a heart attack at first. As this condition is newly recognised, we need to understand the mechanisms behind it to better treat it.

Are there long-lasting effects?

Fatigue, chest pains and lack of energy are the most common continuing symptoms

Most people with takotsubo start a spontaneous process of recovery, within hours or days, but it can take longer for the heart muscle to improve. However, our research at Aberdeen University has shown that not all patients achieve complete recovery. Fatigue, chest pains and lack of energy are the most common continuing symptoms. We are now conducting studies to look at the long-term outcomes for these patients.

If you experience takotsubo, what’s the chance of it happening again?

About 10–15 per cent of people who have had a takotsubo episode will have another episode, and possibly more than one. In those who do have further episodes, the trigger can be different each time.

BHF-funded takotsubo research

Dr Dana Dawson and her team at the University of Aberdeen have been funded by the BHF to find out more about takotsubo syndrome. “We are looking into several possible mechanisms,” she says. “One is the amount and distribution of inflammation in the heart as a result of the stress – this is known as the inflammatory hypothesis.

“We are also looking at metabolic pathways to see how the heart, an organ that needs to feed on a constant basis due to its constant workload, is affected by the decrease in energy production we previously demonstrated in this condition.

Energy production in the heart muscle may adapt to stressful signals and change as a result. These are just two of the big questions we must answer in order to better understand this condition, and both have been generously funded by the BHF.

We will also try to determine if individuals who develop takotsubo may be predisposed. There is a lot more to find out. It’s fascinating research; this is the strongest psychosomatic interaction [where mental state affects physical health] that we know of in medicine.”

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