Takotsubo Cardiomyopathy: “Broken Heart Syndrome”

Takotsubo Cardiomyopathy: “Broken Heart Syndrome”

Introduction

Cardiovascular system is regarded as one of the most vulnerable systems of the human body to stress and the associated damaging effects. These effects are not only documented by the medical communities of the world but also accepted by the population as well. Takotsubo cardiomyopathy, also referred to as Broken Heart Syndrome is a stress associated cardiomyopathy syndrome which is perceived to be seemingly rare syndrome. This syndrome refers to the transients associated with the left ventricular dysfunctions. Broken Heart Syndrome mimics an Acute Coronary Syndrome with similar initial symptoms and conditions which include: Chest pains, ischemic ECG (Electrocardiograph) variations, abnormalities of wall motion and cardiac enzymes elevated levels.

The primary characteristic of Takotsubo Cardiomyopathy is a contractile abnormality which occurs in the left ventricle and leads to the formation of a morphology which resembles a balloon. This abnormality can be detected by employing contrast echo-cardiograph or angiography to the left ventricle. This ventricle defect acts as a causal factor of the contractile defect of the heart's apex. This syndrome was officially located in the studies conducted by Dote in 1991 who named the broken heart syndrome as Takotsubo Cardiomyopathy (Dote et.al, 1991). The primary reason behind this name was the appearance of the defect caused by this syndrome which was similar to the pot used in Japan for catching octopuses (tako and tsubo refer to octopus and pot in Japanese respectively). The dysfunction of the cardiac is not permanent and after following proper treatment, the restoration of contractile functions and ventricle occur in few days to weeks.

Discussion

Pathogenesis

Many patho-physiological mechanisms which are associated with Broken Heart Syndrome remain ambiguous even though the availability of speculations is significant. The theory of elevation in the level of Catecholamine which results from the activation of sympathetic tones is one of the most widely accepted theories. Atherosclerotic plaque transients and multi-vessel coronary spasm's ischemia are other theories associated with this syndrome.

Role of Catecholamine

Abnormalities are observed in the levels circulating Catecholamine which is higher than usual in Takotsubo cardiomyopathy patients. Wittstein in his studies observed dopamine, epinephrine and non-epinephrine plasma levels in the hospitalized patients suffering from Takotsubo cardiomyopathy (Wittstein et.al,). In classical myocardial infarctions' patients, levels of the same chemicals were observed. Upon comparing the levels, Wittstein concluded that the plasma levels of Takotsubo cardiomyopathy patients were up to 7 to 34 times the normal residual plasma levels as compared to a healthy patient and up to 2 to 3 times greater than the plasma levels of classic myocardial infarctions' patients.

The biopsy samples of the patients' left ventricles which were affected from Broken Heart Syndrome, upon histological examination, shown contractions in band necrosis which is a medical condition associated with elevated level of catecholamine. This elevation in the level of catecholamine has a significant toxic reversible effect on the hearts' tissues. This defect has also been documented in the cases of a tumor associated with catecholamine secretion, pheochromocytoma. The left ventricle apex has been observed ...