Stress-induced cardiomyopathy: The broken heart or ‘takotsubo’ syndrome

The fact that an individual may feel ‘broken hearted’ has been known for generations, indeed some patients have been said to ‘die of a broken heart’. The underlying mechanisms of this have always been unclear. A recently identified unique morphological and functional cardiac abnormality has been associated with patients presenting with cardiac symptoms after a significant stressful event. This has since become increasingly recognised across the world and has resulted in the establishment of a diagnostic entity of stress-induced cardiomyopathy.

The first description of this syndrome came from Japan. In patients presenting following a stressful event, the function of the patient’s left ventricle (LV) was distinctly abnormal, with the apical half of the LV described as ballooning while the basal half showed a more normal or increased contraction. The syndrome became known as the apical ballooning syndrome but also ‘takotsubo’ cardiomyopathy because of the similarity of the left ventricular appearance in systole to a Japanese pot (known locally as a takotsubo) used for trapping octopuses. The name has stuck and the most commonly used synonym currently is takotsubo syndrome.

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