Tokotsubo Cardiomyopathy
Just when I thought I had seen just about everything in my long career as an echo tech, something new comes along that shows me that an old dog can learn new tricks. I had this experience the other day when a patient showed up in my lab as a follow up hospital stay for Tokotsubo cardiomyopathy.
Tokotsubo cardiomyopathy is a stress-induced cardiomyopathy that causes a non-ischemic weakening of the cardiac muscle. Another name for it is “broken heart syndrome”. It is now recognized that severe anxiety can cause arrhythmias, chest pain and left ventricular failure. Severe emotional trauma can trigger this syndrome, such events as break ups, deaths in the family, emotional rejection and panic attacks.
Symptoms include chest pain and ECG changes that mimic an anterior wall infarction. Echocardiographically, you would look for anterior wall changes and most signicantly, you should evaluate the apex for a type of bulging that causes the heart to resemble a teapot or fish pot. An angiogram would reveal a normal left anterior descending coronary artery in the face of anterior and apical dysfunction.
The mechanisms that lead to Tokotsubo include multiple coronary artery vasospastic events, micro vascular dysfunction that cannot be detected by angiography, catecholamine induced injury such as the release of epinephrine and norepinephrine during stressful events, and external events such as asthma and diabetes mellitus.
Treatment is palliative once it is determined that coronary artery disease or other causes of cardiomyopathy and left ventricular dysfunction are eliminated. Treatment would include aspirin therapy and temporary inclusion of other heart drugs to stabilize the patient, but most importantly, long term follow up with stress reduction therapy and echocardiography should be emphasized.
In the case of my patient, she had lost her mother several months earlier.
Please read my other blogs on cardiomyopathy on Facebook: Pediatric Echo Sonographers. Or my webpage HeartDefectsSimplified.com
Thank You
Ken Heiden