Tako-tsubo cardiomyopathy: what is it, symptoms, causes and treatment

The heart is one of the most important organs in our body because it allows us to transport oxygen and nutrients through the cardiovascular system that every organ in the body needs to survive.

However, as with other organs, the heart can be affected by several factors. And we’re not just talking about pathogens, but even emotional aspects can come to influence it and even lead to heart events and illnesses. This is what happens with broken heart syndrome or tako-tsubo cardiomyopathy, Which we will talk about throughout this article.

    Tako-tsubo cardiomyopathy: what is it?

    It is called tako-tsubo cardiomyopathy or transient apical dyskinesia a type of coronary artery disease characterized by the presence of a dysfunction of the left ventricle, of a temporary nature, Which happens to have an abnormal beat in the absence of blockage of the arteries or an injury that explains this behavior.

    This is a weakening of the heart muscle, which presents with hypokinesia or kinesia in the most apical parts (at the end of the ventricle, the muscle loses part or all of its mobility).

    The ventricle in question has a particular morphology, with swelling at the bottom or the ball-shaped tip of the ventricle (another of its names is transient apical ablation syndrome) which makes it look similar to the traditional Japanese poppots that give the disorder its name (takotsubo).

    This temporary disorder is also called broken heart syndrome or stress cardiomyopathy because a considerable proportion of cases arise from situations of intense stress or emotional pain, such as those which would result in the death of a loved one, an unexpected break-up, the diagnosis of a dreaded illness or experience of domestic violence.

    Symptoms are very similar to those of acute coronary syndrome or a heart attack: Chest pain and heart failure, there is also an increase in cardiac biomarkers and changes in heart rate visible on the electrocardiogram. The big difference is that in this case the arteries are not blocked, although the blood supply may be reduced. It is a pathology that can appear in people of both sexes and at any age, although it is more common in women between the ages of fifty and seventy.

    While in general we are faced with a temporary disorder which can normalize on its own and with a very favorable prognosis, the truth is that while it is not common they can sometimes cause complications such as (among others) ventricular fibrillation or cardiogenic shock, heart failure, thrombus formation, mitral regurgitation, arrhythmias or rupture of the ventricular wall.

      Main causes and explanatory hypotheses

      Although the causes of tako-tsubo cardiomyopathy are not fully understood in all cases, requiring further research in this regard, yes some typical causes of this alteration are known.

      One of the most validated explanatory theories refers to the fact that many cases of this disorder can be explained by the presence of high levels of catecholamines in the blood (which has been found in over 70% of cases). levels that can be 34 times higher than usual. We mainly talk about adrenaline, a hormone that generates excitement and activates the sympathetic system and therefore generates the activation of the organism.

      In turn, this increase is caused in many cases by experience severe stress, Which can be both emotional (a loss, fear, unexpected and poignant news …) and physical (which have been localized in about 50% of cases, of which about 27% have emotional causes).

      Other theories propose the presence of occlusive microvascular spasms as an explanation for this temporary situation, generating a brief ischemia, the presence of an abnormal orientation of the mitral valve generating an obstruction at the exit of the ventricle or the presence of deficiencies in coronary microvascularization. .

      Treatment of this pathology

      As we mentioned earlier, tako-tsubo cardiomyopathy is a transient disease that usually resolves on its own without leaving any sequelae, and there are complete recovery in 95% of cases in about one to two months. However, when presenting symptoms, it is essential to get to the hospital urgently, as the symptoms are not immediately distinguishable from other much more dangerous coronary heart disease.

      As far as treatment is concerned, as a general rule, the solution would be to keep the subject hydrated and to reduce or eliminate as much as possible the stressors that may have caused the syndrome. It is also possible to administer beta-adrenergic blockers or alpha-adrenergic agonists together with an angiotensin converting enzyme, in order to facilitate blood flow in the acute phase as well as recovery. Likewise, in the event of complications, they should be treated differently depending on the type of abnormality that may occur.

      bibliographical references

      • Núñez-Gil, I., Molina, M., Bernat, I., Ibáñez, B., Ruiz-Mateos, B., García-Rubira, JC, Vives, D., Feltes, G., Luaces, M., Alonso, J., Zamorano, J., Macaya, C., and Fernández-Ortiz, A. (2012). Tako-tsubo syndrome and heart failure: long-term follow-up. Spanish Journal of Cardiology, 65 (11): 992-1002.
      • Obón Azuara, B., Ortas Nadal, MR, Gutiérrez Cia, I. and Villanueva Anadón, B. (2007) Takotsubo cardiomyopathy: transient apical dysfunction of the left ventricle. Critical Care Medicine, 31 (3).
      • Rojas-Jiménez, S. and Lopera-Vall, JS (2012), Takotsubo cardiomyopathy, the great imitator of acute myocardial infarction. Tower. CES Med 26 (1): 107-120.

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