Takotsubo cardiomyopathy

Takotsubo cardiomyopathy, or broken heart syndrome, is a condition often triggered by physical or emotional stress. Read about takotsubo symptoms and treatment, and hear from others who’ve experienced it.

Takotsubo cardiomyopathy is a heart event that happens when part of the heart muscle suddenly becomes weakened or “stunned”, causing symptoms like a heart attack.

During a takotsubo event, the heart’s largest chamber (the left ventricle) swells and changes shape. This stops the heart pumping properly and reduces blood flow out of the heart.

The condition gets its name from the Japanese term ‘tako-tsubo’ – a traditional octopus pot that looks similar to the left ventricle during a takotsubo event (see diagram below).

Two hearts. One with a left ventricle the normal shape after it contracts. The other shows an enlarged left ventricle

Takotsubo is also called stress-induced cardiomyopathy or broken heart syndrome because, in some cases, it is triggered by a stressful event. You may also hear it referred to as apical-ballooning.

What causes takotsubo cardiomyopathy?

Medical experts do not know the exact cause of takotsubo cardiomyopathy. However, it’s thought that about a third of cases are triggered by physical stress and about a third are triggered by emotional stress.

Triggers can include things like:

  • car accident or other extreme physical event
  • asthma attack
  • surgery
  • acute illness
  • death of a loved one
  • marriage breakup
  • a frightening medical diagnosis
  • job loss
  • sudden loss of money
  • domestic abuse.

Sometimes takotsubo can occur after an extremely happy event, such as winning a large sum of money or a family reunion.

In about a third of cases, people are unable to identify any kind of stress that might have triggered their event. It is not an inherited condition like other cardiomyopathies, such as hypertrophic cardiomyopathy.

You are more likely to experience takotsubo if you’re female and you’ve been through menopause (stopped having periods). According to an international registry of people with takotsubo, approximately 90 percent of people who experience it are women, with an average age of 66.

Symptoms of takotsubo cardiomopathy

Takotsubo symptoms are very similar to those of a heart attack. They include:

  • chest pain
  • pressure or tightness in the chest
  • pain in the arm and shoulders
  • breathlessness
  • nausea and/or vomiting.

If you experience these symptoms call 111 immediately and wait for an ambulance. Do not drive yourself to hospital.

How is takotsubo diagnosed?

Clinicians will use a number of tests to rule out a heart attack and confirm a diagnosis of takotusbo cardiomyopathy. These may include:

  • A full physical exam and medical history.
  • Blood tests to look for evidence of damage to the heart muscle.
  • An ECG (electrocardiogram) to measure electrical activity in your heart.
  • An angiogram to examine the heart’s arteries.
  • An echocardiogram (echo) test (PDF), which uses sound waves to examine your heart muscle.
  • A cardiac computerised tomography (CT) scan and/or a magnetic resonance imaging (MRI) scan to provide more detailed images of the heart if necessary.

How does takotsubo cardiomyopathy differ from a heart attack?

Takotsubo and a heart attack share very similar symptoms. However they are two different types of heart condition.

A heart attack occurs because of a blockage in an artery, usually as a result of coronary artery disease. During a takotsubo event there is no blockage in the arteries, instead there is temporary ‘stunning’ of heart muscle.

Takotsubo complications

Takotsubo doesn’t always result in permanent damage to the heart, although full recovery may take some time. Recent research shows the effects may last much longer than first thought.

Complications related to the initial takotsubo event can include:

Ongoing symptoms after the event vary with each person’s condition but can include:

  • tiredness
  • breathlessness
  • chest pains
  • lack of energy.

Takotsubo cardiomyopathy treatment

Most people will stay in hospital while doctors confirm a diagnosis of takotsubo and for the initial recovery period.

In the short-term you may be given medication to help your recovery. These medications may include one or more of the following:

  • ACE inhibitors and/or beta blockers to help your heart function while it recovers.
  • Diuretics to reduce any fluid build-up that has occurred because the heart hasn’t been pumping properly.
  • Aspirin or anticoagulants to reduce your risk of blood clots.

Will it happen again?

The chance of having a second event is relatively low. Current research suggests takotsubo reoccurs in 10 - 15% of people.

Recovering from takotsubo

Many people recover well from a takotsubo event, but the length of time recovery takes varies from person to person and clinicians are still researching the long-term effects of the condition.

Some people may recover fully in a matter of weeks or over a few months. However, more recent research papers, published in the medical journals European Heart Journal and Circulation suggest that the condition often has longer lasting effects.  

Everyone’s recovery will be different and it’s important that you go at a pace that’s suitable for you.

It may be helpful to hear from others who have experienced takotsubo. Read about Sarah’s journey with takotsubo or connect with other people on the international Takotsubo Facebook support group.

Attending a cardiac rehabilitation class can be a great way to learn more about recovering from a heart event and get support from others. Talk to your cardiac rehab nurse about the services in your area that best meet your needs. You can find contact details on our heart help directory.

Exercise after a takotsubo event

You may feel anxious about returning to exercise – especially if you were exercising when your takotsubo event occurred. However, some form of regular exercise is important for your recovery and your ongoing physical and mental health.

It’s a good idea to discuss your exercise plan with your cardiac nurse specialist or your cardiologist before you start.

A green prescription is another way to get exercise advice. The green prescription is a free government-run programme that gives you access to a qualified exercise coach. You can find out how to contact your local green prescription provider on the Ministry of Health website

Takotsubo research

Takotsubo was first recognised in 1990 and a lot of research still needs to be done to find out more about it.

National and international research into takotsubo is ongoing. If you want to participate or find out more email Mandy Fish at Auckland District Health Board or phone +64 9 307 4949 ext 24366.