Takotsubo syndrome, also known as “broken-heart syndrome,” is a stress-induced cardiomyopathy. In Japanese, Tako-tsubo is a word to describe a contraption that is used to catch octopuses.1 This syndrome, which was first described in 1990 by Sato and associates in Japan, usually occurs secondary to emotional stress.2
A 5-patient, single-center study in 2007 by Patel and colleagues3 concluded that African American women may present with atypical symptoms associated with takotsubo syndrome. However, our patient had a typical clinical presentation. In a study by Qaqa and associates,4 African American and non–African American patients were found to have similar presenting symptoms of takotsubo syndrome.
Postmenopausal women are at higher risk for takotsubo syndrome following emotional stress.1,5 This suggests that the disease may be caused by high levels of catecholamines. Patients usually present with symptoms similar to those of coronary artery disease, with ST-segment depression or elevation and T-wave changes.1,6 Most patients will also present with a prolonged QTc and elevation of cardiac enzyme levels.1 Therefore, according to principles of Bayesian analysis, the diagnosis of coronary artery disease and myocardial infarction should be maintained until proved otherwise.2
Apical ballooning on cardiac arteriography with left ventriculogram is typical of takotsubo syndrome and confirms the diagnosis. As seen in Figure 2, apical ballooning and basal hypercontraction can be visualized during systole. Another significant diagnostic finding is apical wall dyskinesia on an echocardiogram.1,2
Although takotsubo syndrome can cause significant morbidity, the treatment is primarily supportive and self-reversal occurs within a few weeks.7 If the patient is hemodynamically stable, β-blockers may be used. In patients with takotsubo syndrome, there is a risk of ventricular thrombus formation as a result of wall akinesia; therefore, anticoagulation may be indicated.8