TAKO-TSUBO SYNDROME Tako-Tsubo Cardiomyopathy also known as Stress Cardiomyopathy

o Transient (Catecholaminergic) Myocardial Stunning o Transient (neurogenic) Myocardial Stunning

All Images on this site Striped Giraffe Press, December 2005. All rights reserved.

www.stripedgiraffe.com www.stages-of-shock.com contact Tako-Tsubo syndrome is a dreadful illness (albeit quite rare) that appears under circumstances of exceptional and extreme stress, at times associated with anger. If this is happening to you, you should try to calm yourself down, if at all possible (although most patients recover completely if supported adequately in a hospital).

Please read one column after the other.

Some comments on TakoTsubo Syndrome

About 70-80% of cases of Takotsubo Syndrome (TTS) occur in post-menopausal women under some form of extreme, exceptional and prolonged mental stress,... with no good way out, no relief and often feeling deep resentment (such as the loss of a dear one...)
(Note: a word of caution... , in a minority of patients (<20%) the stress is physical (such as massive trauma, surgery or severe pain, or other type of stress. In very rare cases, no "cause" can be found). Tako-tsubo Cardiomyopathy or Syndrome is also known as:

Shape of the Left Ventricle in Tako-Tsubo Cardiomyopathy

Normal left ventricular contraction

Abnormal contraction of left ventricle taking the shape of a "TakoTsubo"

neurogenic myocardial stunning, stress cardiomyopathy stress-induced cardiomyopathy, transient left ventricular apical ballooning, "ampulla" cardiomyopathy "broken heart syndrome".

Actual Left ventriculogram in a patient with tako-tsubo syndrome.

"Tako-tsubo" is the japanese name for octopus traps that fishermen still use to catch octopus. In this syndrome, the heart (left ventricle) takes the shape of an octopus trap (tako-tsubo). How about that!

ECG Changes in Tako-Tsubo Cardiomyopathy

The electrocardiogram can evolve through 3 stages:
(note: this is NOT always the case)

Normal (baseline tracing i.e. in V5) :

Post-menopausal woman Cardiac ultrasound in the E.R. Day 1 of a tako-tsubo syndrome: the left ventricular tip (apex) is "paralyzed"

Stage 1: acute stage,

Summary:
Tako-tsubo syndrome can appear because of an extremely, out of the ordinary, stressful episode, especially if it is associated with anger, resentment , and/or despair, mainly in women (men tend to drop dead or have a real heart attack because of stress... true! Hey! STRESS IS BAD FOR ANYBODY!). It is therefore key to try to calm yourself down (if necessary with outside help from friends and health practitioners) so that you don't let your octopus out of its tako-tsubo. Once the nervous system is so terribly activated you risk the following (especially women) with or without a full blown tako-tsubo syndrome:

neurogenic:

myocardial stunning, heart failure, cardiogenic shock, chest pressure-pains (similar to angina), coronary spasm, shortness of breath, palpitations (arrhythmia, sometimes extremely serious)...

Treatment: Tako-tsubo syndrome is only treated with support measures. Outcome: Excellent in 95% of cases. Recovery takes place over a few days with
full recovery over a few weeks. Recurrence (another surprise) is extremely rare.

Root cause of tako-tsubo syndrome: Stress appears to be the underlying root cause in many cases. Because of this, some have investigated an excessive norepinephrine release over the heart muscle. Because this mechanism is not yet proven scientifically to satisfaction, we are a bit helpless for the treatment of this syndrome (we really only have standard support measures that we give to other patients with standard heart failure). There are some attempts to give a calcium channel blocker to prevent coronary spasm, but there is no solid literature on that. Besides, patients often have low blood pressure, prevent us from giving a vasodilator such as a calcium channel blocker. Like everything else: better prevent and recognize tako-tsubo syndrome rather than wait for the full syndrome.

Now: for a less serious view of this syndrome. The theory of everything given away by a giraffe...

Pathophysiology of Tako-Tsubo syndrome explained --goofy "theory of everything", using all 6 character actors ...
(Japanese researchers have come up with first papers and attempts to explain this syndrome... they should tie up all things under 6 character actors... here it is for the first time... I hope that this gets me 1/2 of their Nobel Prize...ahahahah!)

6 character actors

1. 2. 3. 4. 5. 6.

tako-tsubo (octopus trap) the octopus itself some serious stress, anger, resentment the central and sympathetic nervous system norepinephrine being released uncontrollably the heart (the target of all this)

1. The Octopus is resting in its Tako-Tsubo - Do NOT irk it !

2. The Octopus is unhappy and on a prowl

3. The Octopus has found its target - the heart

4. Oh! No ! -- Big trouble ! -- The Octopus IS the 5

Conclusion...

Now for another odd thing: the "inverted Tako-Tsubo syndrome"("squid syndrome")
This is much rarer than tako-tsubo syndrome ..... even more mind boggling syndrome... This syndrome can also be transient and reversible... How about the inverted tako-tsubo syndrome that has been recently described in patients with severe intra cranial process or with pheochromocytoma crisis (references below)! In those rare cases, instead of the tip of the left ventricle becoming stunned and "paralyzed", the tip of the left ventricle is hyperdynamic ("hypercontracting") while it is the base of the heart that is stunned and "paralyzed". How about that! Here is an example of inverted tako-tsubo syndrome in a patient with pheochromocytoma who was admitted to our hospital. (this type of contraction makes me think of a... squid taking off...)

1.

Ennezat PV, Pesenti-Rossi D, Aubert JM, Rachenne V, Bauchart JJ, Auffray JL, Logeart D, Cohen-Solal A, Asseman P. Transient left ventricular basal dysfunction without coronary stenosis in acute cerebral disorders: a novel heart syndrome (inverted Takotsubo). Echocardiography. 2005 Aug;22(7):599-602.

2.

Sanchez-Recalde A, Costero O, Oliver JM, Iborra C, Ruiz E, Sobrino JA. Images in cardiovascular medicine. Pheochromocytoma-related cardiomyopathy: inverted Takotsubo contractile pattern. Circulation. 2006 May 2;113(17):e738-9.

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Take a deep breath and relax (but don't breath to fast ,... or you will become dizzy and panicky...)

1 JULY 2010