Broken Heart Syndrome

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Takotsubo cardiomyopathy, also known as stress cardiomyopathy and “broken heart syndrome,” is a sudden, transient cardiac syndrome that involves dramatic left ventricular apical akinesis and mimics acute coronary syndrome (ACS). It was first described in Japan in 1990 by Sato et al.

Patients often present with chest pain, have ST-segment elevation on electrocardiography (ECG), and have elevated cardiac enzyme levels consistent with myocardial infarction (MI). [1] [2, 3] However, when the patient undergoes cardiac angiography, left ventricular (LV) apical ballooning is present, and there is no significant coronary artery stenosis.

The Japanese word takotsubo translates to “octopus pot,” which refers to the resemblance of the LV shape during systole to this pot on imaging studies. Although the exact etiology of takotsubo cardiomyopathy remains unknown, the syndrome appears to be triggered by a significant emotional or physical stressor. [1, 5]

The modified Mayo Clinic criteria for diagnosis of takotsubo cardiomyopathy [6] can be applied to a patient at the time of presentation. The diagnosis requires the presence of all four of the following:

  • Transient hypokinesis, dyskinesis, or akinesis of the LV midsegments, with or without apical involvement; the regional wall-motion abnormalities extend beyond a single epicardial vascular distribution, and a stressful trigger is often, but not always, present
  • Absence of obstructive coronary disease or angiographic evidence of acute plaque rupture
  • New ECG abnormalities (either ST-segment elevation and/or T-wave inversion) or modest elevation in the cardiac troponin level
  • Absence of pheochromocytoma or myocarditis [6]


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