A Rare Coronary Event: Takotsubo Cardiomyopathy

The term “takotsubo” is the Japanese word for octopus trap.

Takotsubo cardiomyopathy is a transient, reversible systolic dysfunction of the apical ventricular tissue without obvious structural damage.

When this condition develops, the heart’s left ventricular apex balloons, creating a shape similar shape to an octopus trap.

Takotsubo cardiomyopathy is also known as “broken heart syndrome” because emotionally or physically stressful events create catecholamine release that can precipitate an episode.

Emotional trauma like the loss of a loved one or accidental or idiosyncratic physical trauma can trigger takotsubo cardiomyopathy, and post-menopausal women are at the greatest risk of developing the condition.

A team of researchers recently documented a case of takotsubo cardiomyopathy following cardiac surgery in the Journal of Cardiac Surgery.

A 72-year-old female presented to the emergency room with breathlessness, chest pain, and peripheral edema. Her treatment team found an aorta-to-right atrium 6 mm fistula with a left-to-right shunt and severe tricuspid insufficiency (annulus diameter 41 mm).

The patient had corrective surgery through medial sternotomy with cardiopulmonary bypass and moderate hypothermia. T-troponin and creatine phosphokinase-MB were elevated (0.248 ng/mL and 4.65 ng/mL).

After the surgery began, the patient’s echocardiogram showed severe left ventricular dysfunction (ejection fraction 29%) and systolic apical ballooning with akinesia—findings that are consistent with takotsubo cardiomyopathy.

Surgery can be a major stressor and trigger massive catecholamine release itself.

Myocardial stunning secondary to the cardiopulmonary bypass was hypothesized as the causative event.

The medical staff initiated the standard short-term treatment for takotsubo cardiomyopathy: combined beta-blocker, aspirin, and diuretic therapy.

Beta-blockers may be continued indefinitely to prevent recurrence, but evidence is scant to support this recommendation.

The patient recovered to an ejection fraction of 46% after 12 days and was discharged 48 hours later.

Atrioventricular (specifically mitral) valve replacement has been associated with takotsubo cardiomyopathy.

Takotsubo cardiomyopathy may be a cause of papillary muscle rupture that spurs mitral valve replacement surgery.

Deferring elective cardiac surgery and limiting inotropic agent use hasten recovery from takotsubo cardiomyopathy.