Takotsubo cardiomyopathy (also known as stress cardiomyopathy or broken heart syndrome) is a temporary but acute weakening of the left ventricle, most commonly triggered by intense physical or emotional stress. The condition mimics a heart attack in its presentation but, unlike a heart attack, is not caused by blockage of a coronary artery.
During an episode, the apex (lower tip) of the left ventricle balloons outwards and stops contracting effectively, while the base of the ventricle continues to pump normally. This gives the heart a distinctive shape on imaging resembling a takotsubo (an octopus-trapping pot used in Japanese fishing), which gives the condition its name. The cause is thought to involve a surge of stress hormones such as adrenaline temporarily stunning the heart muscle.
Takotsubo most commonly affects postmenopausal women and can be triggered by sudden emotional shock (bereavement, relationship breakdown, frightening news), physical illness, surgery, or medical procedures. Symptoms include chest pain, breathlessness, and ECG changes indistinguishable from a heart attack at presentation. Blood troponin levels are elevated. Coronary angiography and left ventriculography or echocardiography confirm the diagnosis by showing the characteristic ballooning pattern and normal coronary arteries.
In most cases, takotsubo resolves spontaneously within days to weeks, with the heart returning to normal function. However, in the acute phase it can cause cardiogenic shock, acute pulmonary oedema, and, less commonly, cardiac arrest from arrhythmia or left ventricular outflow obstruction. Treatment is supportive during the acute phase. Recurrence is possible (around 5 to 10% over 10 years), and some patients benefit from beta-blocker therapy long-term.
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