Overview
Stress cardiomyopathy, also known as Takotsubo cardiomyopathy or ‘broken heart syndrome’, is a type of non-ischaemic cardiomyopathy characterised by a sudden transient weakening and ballooning of the myocardium.
Its pathophysiology is not fully understood, but it is thought that significant elevations in catecholamines may cause microvascular spasms and injury to the myocardium.
Epidemiology
- Stress cardiomyopathy is more common in post-menopausal women
- Oestrogen promotes vasodilation in the cardiovascular system, therefore, in times of vasoconstriction, it is exaggerated in post-menopausal women
Presentation
Patients present with chest pain with or without features of heart failure following physical or psychological stress (e.g. finding out bad news, such as a relative passing away). Features include:
Investigations
- ECG:
- May show ST-elevation
- Troponins:
- May be mildly elevated
- Transthoracic echocardiogram:
- Shows apical ballooning of the left ventricle
Management
Overview
Management involves observation and monitoring, along with supportive treatment. Most patients improve with supportive treatment.
