Octopus Jar

21Feb07

I learned something new today in conference. Takotsubo. The dreaded broken-heart syndrome. Otherwise known as octupus-jar. It’s when you get a heart attack from an emotionally stressful event even though your heart is normal.

As from Up to Date:

Stress-induced (takotsubo) cardiomyopathy
— Stress-induced cardiomyopathy, also called transient left ventricular (LV) apical ballooning, broken heart syndrome, and, in Japan, takotsubo cardiomyopathy, is an increasingly reported syndrome characterized by transient dysfunction of the apical portion of the left ventricle, with compensatory hyperkinesis of the basal walls, producing ballooning of the apex with systole in the absence of significant coronary artery disease.

Takotsubo cardiomyopathy was first described in Japan, and the name of the disorder is taken from the Japanese name for an octopus trap (tako-tsubo) that has a similar configuration to LV apical ballooning. Subsequently, stress-induced cardiomyopathy has been described in non-Asian populations, including the United States and Europe.

Stress-induced cardiomyopathy is much more common in women than men. In a review of seven series, postmenopausal women accounted for 82 to 100 percent of cases, with a mean age of 62 to 75 years.

PATHOGENESIS — The onset of stress-induced cardiomyopathy is typically triggered by acute medical illness or intense emotional or physical stress (eg, death of relatives, particularly if unexpected, domestic abuse, arguments, catastrophic medical diagnoses, devastating financial or gambling losses, natural disasters).

The pathogenesis of this disorder is not well understood. Although the clinical presentation simulates that of an acute, usually ST elevation, myocardial infarction, coronary arteriography, by definition, shows no critical lesions.

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