Is Takotsubo Cardiomyopathy a Heart Attack?

Pictured is an electrocardiogram readout. Takotsubo cardiomyopathy is heart pain and other symptoms in response to physical or emotional stress. It's also called "broken heart syndrome."

Takotsubo cardiomyopathy is not a heart attack. People with takotsubo cardiomyopathy usually do not have heart disease. 

Takotsubo cardiomyopathy, also called stress cardiomyopathy or "broken heart syndrome," is a heart condition that causes sudden and temporary chest pain, difficulty breathing, and lightheadedness and fainting. It commonly occurs in older women and may be triggered by intense emotional or physical stress such as the death of a loved one (this is why it’s sometimes called broken heart syndrome), an acute illness, or even a stressful argument.

Symptoms of takotsubo cardiomyopathy (stress cardiomyopathy or broken heart syndrome) often resemble those of a heart attack, however, it is not a heart attack. 

A significant feature of symptoms of takotsubo cardiomyopathy is that they occur in association with a physically or emotionally stressful trigger event. 

Symptoms of takotsubo cardiomyopathy include:

• Sudden chest pain
• Shortness of breath
• Palpitations
• Nausea
• Vomiting
• Lightheadedness/fainting
• Cardiogenic shock (rare)

The exact cause of takotsubo cardiomyopathy (stress cardiomyopathy or broken heart syndrome) is unknown, but several theories to explain the cause include:

• Multivessel coronary artery spasm 
• Impaired cardiac microvascular function 
• Impaired myocardial fatty acid metabolism 
• Acute coronary syndrome (ACS) with reperfusion injury (a type of blood vessel damage)
• Endogenous catecholamine-induced myocardial stunning and microinfarction (a specific heart malfunction)
• Underlying coronary endothelial dysfunction (coronary artery constriction)

A significant risk factor for takotsubo cardiomyopathy is an emotional or physical stressor or neurologic injury preceding the symptoms. Stressors/triggers may include: 

• News of the death of a loved one 
• Legal problems 
• Natural disasters 
• New financial problems 
• Motor vehicle accidents
• A newly diagnosed serious medical condition 
• Worsening of chronic physical illness 
• Surgery 
• Stay in an intensive care unit (ICU)
• Use of or withdrawal from illegal drugs 
• Near-drowning episodes
• Seizures

A doctor will start with a medical history and physical exam to diagnose takotsubo cardiomyopathy (stress cardiomyopathy or broken heart syndrome). Because the symptoms of takotsubo cardiomyopathy resemble those of a heart attack, tests need to be ordered to determine the cause of the symptoms, such as:

• Blood tests 
  • Cardiac enzymes such as troponin I (TnI) and troponin T (TnT)
  • Brain natriuretic peptide (BNP) levels
• Chest X-ray 
• Electrocardiogram (ECG)
• Echocardiogram (echo) 
• Cardiac catheterization (cardiac cath) 
• Cardiac magnetic resonance imaging (MRI)

Because the symptoms of takotsubo cardiomyopathy (stress cardiomyopathy or broken heart syndrome) resemble a heart attack, patients should be taken to a hospital’s emergency department immediately for a proper diagnosis and treatment. In the emergency department, treatment may include: 

• Addressing the airway, breathing, and circulation (ABC)
• Establishing intravenous (IV) access
• Providing supplemental oxygen and cardiac monitoring 
• Testing such as electrocardiography (ECG), chest radiography, cardiac biomarker levels, brain natriuretic peptide (BNP) level, and other laboratory studies

Medications that may be indicated include:

• Aspirin 
• Beta-blockers 
• Nitrates 
• Heparin or enoxaparin 
• Platelet glycogen (GP) IIb/IIIa inhibitors 
• Morphine 
• Clopidogrel 

Patients with takotsubo cardiomyopathy will usually be admitted to the hospital, where care is often supportive and may include:

• Beta blockers 
• Anticoagulation therapy

After being discharged from the hospital a patient will need follow-up visits with a cardiologist.

The prognosis in takotsubo cardiomyopathy (stress cardiomyopathy or broken heart syndrome) is usually very good, with nearly 95% of patients experiencing complete recovery within four to eight weeks. 

Complications occur in about 20% of cases of takotsubo cardiomyopathy, and include:

• Heart failure with and without fluid in the lungs (pulmonary edema)
• Cardiogenic shock 
• Left ventricular (LV) outflow obstruction 
• Mitral regurgitation (backflow of blood through a heart valve)
• Ventricular arrhythmias 
• LV mural thrombus formation (clots)
• LV free-wall rupture 
• Death