What is Stress Cardiomyopathy?

Takotsubo cardiomyopathy, or stress cardiomyopathy, is a weakening of the heart muscle as a result of significant emotional or physical stress. Triggers may include sudden illness, a serious accident, a natural disaster, loss of a loved one or intense fear. The condition is sometimes known as broken-heart syndrome. The name “takotsubo” comes from the Japanese word for a kind of octopus trap because the left ventricle takes on a shape resembling a fishing pot. 

In takotsubo cardiomyopathy, or stress cardiomyopathy, stress triggers an onset of chest pain, breathlessness and other symptoms that mimic a heart attack. An electrocardiogram (EKG) may even show abnormalities similar to those found in some heart attacks — namely changes known as ST-segment elevation. The left ventricle temporarily enlarges and doesn’t pump well, while the rest of the heart functions normally or with even more forceful contractions. 

Thankfully, stress cardiomyopathy is typically temporary and reversible. 

Takotsubo cardiomyopathy was first identified in Japan in 1990. The majority of cases reported since that time have involved elderly women. Recent research has suggested that the condition may be present in as many as 1 in 20 women experiencing a heart attack. 

Signs and Symptoms

Takotsubo cardiomyopathy symptoms follow a period of severe stress, are often indistinguishable from a heart attack and may include: 

• Chest pain (often sudden and intense)
• Shortness of breath
• Rapid or irregular heartbeat 
• Sweating
• Dizziness

Causes

The exact cause of takotsubo or stress cardiomyopathy is unclear. Many researchers believe a surge of stress hormones might temporarily damage the heart. There are no preventable causes of takotsubo cardiomyopathy. Triggers of stress cardiomyopathy can include:

• Financial stressors
• Surgery
• Loss of a loved one
• Asthma attack
• Chronic illness or diagnosis

Risk Factors

Risk factors that could contribute to takotsubo/stress cardiomyopathy include: 

• Age: Most cases occur in people over the age of 50. 
• An intense physical or emotional event: A stressful trigger – such as the unexpected death of a loved one, a negative medical diagnosis, a financial or job loss, divorce, physical abuse, a car accident, major surgery, a natural disaster or intense fear – often precedes stress induced cardiomyopathy. 
• Certain drugs: Some drugs used to treat severe allergic reactions, nerve problems in diabetes, depression or hypothyroidism may cause a surge of stress hormones that contribute to takotsubo cardiomyopathy. 
• Gender: This condition affects women much more often than men. 
• Neurological conditions:  People who have certain neurological disorders, previous head injuries or seizure disorders seem to be at an increased risk.
• Previous or current psychiatric disorder: Common psychiatric disorders like anxiety or depression can increase a person’s risk of developing takotsubo cardiomyopathy. 

Diagnosis

Diagnosis of takotsubo or stress cardiomyopathy is made by looking for certain indicators and ruling out a heart attack and other heart conditions. Tests may include:

• Blood test: Blood tests check the levels of certain fats, cholesterol, sugar and protein in the blood that could indicate heart conditions.
• Chest X-ray: A common imaging test of the lungs, heart and aorta.
• Coronary angiography: This procedure often is done with cardiac catheterization. During the procedure, dye that can be seen on an X-ray is injected into the heart chambers or coronary arteries. The dye lets a physician study blood flow through the heart and blood vessels to detect any blockages.
• Echocardiogram: This ultrasound exam uses soundwaves to take moving pictures of the heart’s chambers and valves.
• Electrocardiogram (EKG): This test measures the electrical activity of the heart and can help determine if parts of the heart are enlarged, overworked or damaged. The heart’s electrical currents are detected by 12 to 15 electrodes that are attached to the arms, legs and chest via sticky tape.
• Magnetic resonance imaging (MRI): A large magnet, radio waves and a computer are used to produce pictures of the heart and blood vessels.

Prevention

There is no known means of preventing takotsubo cardiomyopathy. It appears to be stress-related and many of the stresses we face in life are unpredictable in timing and intensity. That said, stress management and relaxation techniques may prove beneficial in decreasing the incidence of this condition. Also beneficial are healthy dietary and exercise habits, as is limiting alcohol and tobacco consumption. 

Learning problem-solving techniques can also help relieve stress when making decisions.

Prognosis

The prognosis for people with takotsubo cardiomyopathy is typically excellent. About 95 percent of patients experience complete recovery within one to two months. Symptoms usually reverse themselves. In some cases, however, the heart’s new shape is permanent, and can be a source of future health issues. 

Treatment

Though there is no standard stress cardiomyopathy treatment, your physician may prescribe: 

• A Hospital Stay: After heart attack has been ruled out, most people stay in the hospital briefly while they recover.
• Medication: The physician may prescribe heart medications, such as angiotensin-converting enzyme (ACE) inhibitors, beta blockers or diuretics to help reduce the heart’s workload during recovery.

Complications

In very rare cases, takotsubo cardiomyopathy complications can be fatal. However, most people with the condition recover quickly and don’t have long-lasting effects. 

Rare, but possible, takotsubo cardiomyopathy complications include: 

• Heart failure
• Low blood pressure
• Pulmonary edema – a backup of fluid into the lungs
• Recurrence with another stressful event

Prognosis

Takotsubo cardiomyopathy is not usually life-threatening. If, however, you experience symptoms such as chest pain, shortness of breath, and rapid or irregular heartbeat, you should seek medical help. These may indicate the presence of a more serious underlying condition. Takotsubo cardiomyopathy is treated by Baptist Health cardiologists.

Baptist Health is known for advanced, superior care for patients with heart disease and the diagnosis, management and treatment of takotsubo or stress cardiomyopathy. You will appreciate timely appointments and a professional, friendly atmosphere where we take time to listen to your concerns. At Baptist Health, you have access to the region’s most comprehensive, multidisciplinary team of takotsubo (stress) cardiomyopathy doctors and innovative therapies, including many available only through specialized clinical trials. In every way, we work to demonstrate the utmost in excellent care to those who trust us with their health. 

Causes

The exact cause of takotsubo or stress cardiomyopathy is unclear. Many researchers believe a surge of stress hormones might temporarily damage the heart. There are no preventable causes of takotsubo cardiomyopathy. Triggers of stress cardiomyopathy can include:

• Financial stressors
• Surgery
• Loss of a loved one
• Asthma attack
• Chronic illness or diagnosis

Risk Factors

Risk factors that could contribute to takotsubo/stress cardiomyopathy include: 

• Age: Most cases occur in people over the age of 50. 
• An intense physical or emotional event: A stressful trigger – such as the unexpected death of a loved one, a negative medical diagnosis, a financial or job loss, divorce, physical abuse, a car accident, major surgery, a natural disaster or intense fear – often precedes stress induced cardiomyopathy. 
• Certain drugs: Some drugs used to treat severe allergic reactions, nerve problems in diabetes, depression or hypothyroidism may cause a surge of stress hormones that contribute to takotsubo cardiomyopathy. 
• Gender: This condition affects women much more often than men. 
• Neurological conditions:  People who have certain neurological disorders, previous head injuries or seizure disorders seem to be at an increased risk.
• Previous or current psychiatric disorder: Common psychiatric disorders like anxiety or depression can increase a person’s risk of developing takotsubo cardiomyopathy. 

Diagnosis

Diagnosis of takotsubo or stress cardiomyopathy is made by looking for certain indicators and ruling out a heart attack and other heart conditions. Tests may include:

• Blood test: Blood tests check the levels of certain fats, cholesterol, sugar and protein in the blood that could indicate heart conditions.
• Chest X-ray: A common imaging test of the lungs, heart and aorta.
• Coronary angiography: This procedure often is done with cardiac catheterization. During the procedure, dye that can be seen on an X-ray is injected into the heart chambers or coronary arteries. The dye lets a physician study blood flow through the heart and blood vessels to detect any blockages.
• Echocardiogram: This ultrasound exam uses soundwaves to take moving pictures of the heart’s chambers and valves.
• Electrocardiogram (EKG): This test measures the electrical activity of the heart and can help determine if parts of the heart are enlarged, overworked or damaged. The heart’s electrical currents are detected by 12 to 15 electrodes that are attached to the arms, legs and chest via sticky tape.
• Magnetic resonance imaging (MRI): A large magnet, radio waves and a computer are used to produce pictures of the heart and blood vessels.

Prevention

There is no known means of preventing takotsubo cardiomyopathy. It appears to be stress-related and many of the stresses we face in life are unpredictable in timing and intensity. That said, stress management and relaxation techniques may prove beneficial in decreasing the incidence of this condition. Also beneficial are healthy dietary and exercise habits, as is limiting alcohol and tobacco consumption. 

Learning problem-solving techniques can also help relieve stress when making decisions.

Prognosis

The prognosis for people with takotsubo cardiomyopathy is typically excellent. About 95 percent of patients experience complete recovery within one to two months. Symptoms usually reverse themselves. In some cases, however, the heart’s new shape is permanent, and can be a source of future health issues. 

Treatment

Though there is no standard stress cardiomyopathy treatment, your physician may prescribe: 

• A Hospital Stay: After heart attack has been ruled out, most people stay in the hospital briefly while they recover.
• Medication: The physician may prescribe heart medications, such as angiotensin-converting enzyme (ACE) inhibitors, beta blockers or diuretics to help reduce the heart’s workload during recovery.

Complications

In very rare cases, takotsubo cardiomyopathy complications can be fatal. However, most people with the condition recover quickly and don’t have long-lasting effects. 

Rare, but possible, takotsubo cardiomyopathy complications include: 

• Heart failure
• Low blood pressure
• Pulmonary edema – a backup of fluid into the lungs
• Recurrence with another stressful event

Prognosis

Takotsubo cardiomyopathy is not usually life-threatening. If, however, you experience symptoms such as chest pain, shortness of breath, and rapid or irregular heartbeat, you should seek medical help. These may indicate the presence of a more serious underlying condition. Takotsubo cardiomyopathy is treated by Baptist Health cardiologists.

Baptist Health is known for advanced, superior care for patients with heart disease and the diagnosis, management and treatment of takotsubo or stress cardiomyopathy. You will appreciate timely appointments and a professional, friendly atmosphere where we take time to listen to your concerns. At Baptist Health, you have access to the region’s most comprehensive, multidisciplinary team of takotsubo (stress) cardiomyopathy doctors and innovative therapies, including many available only through specialized clinical trials. In every way, we work to demonstrate the utmost in excellent care to those who trust us with their health.