Takotsubo cardiomyopathy (TCM) / stress cardiomyopathy / "broken heart"

introduction

1st described in Japan in 1990 by Sato et al.
transient cardiomyopathy which appears to be caused by persistent high levels of circulating catecholamines as a result of an acute stress reaction such as the sudden death of a loved one
patients may present with features of acute myocardial infarction (AMI/STEMI/NSTEMI) or congestive cardiac failure and while echocardiography will demonstrate ventricular dysfunction mainly of the mid-segments and apical segments (on imaging, ventricles have the shape of a takotsubo or fisherman's octopus pot), angiography is normal unless there is pre-existing coronary disease.
1-3% mortality rate
95% recover from the cardiomyopathy within 4-8wks
20% develop complications such as:
- LVF
- cardiogenic shock
- LV outflow obstruction
- mitral incompetence
- VT or VF
- LV mural wall thrombus
- LV free wall rupture
~3% have recurrence
ECG changes may include:
- ST elevation in anterior and inferior leads
- diffuse T wave inversion with poor R-wave progression
there may be a modest rise in serum troponin levels

accounts for ~2% of cases of acute myocardial infarction (AMI/STEMI/NSTEMI)
most cases are Asian or Caucasian
- a US study of almost 200,000 patients published in 2025 showed 83% were female, 80% were white, White individuals had the highest TC incidence rate, followed by Native Americans, whereas Black people had the lowest incidence. TC patients had a high burden of cardiovascular complications, including atrial fibrillation (20%), CHF (36%), cardiogenic shock (6.6%), stroke (5.3%), and myocardial rupture (0.02%). Mortality was double in males (11.2%) compared to females (5.5%). ¹⁾
90% of reported cases are in post-menopausal women
mean age is 67yrs although it can occur in children and young adults
most cases follow severe psychological or physical stress such as:
- death of a loved one - hence the reference to “broken heart”
- financial or health mishaps including news of major medical conditions
- major trauma such as a car accident, surgery or ICU
- following a near-drowning
cases have been reported following following cocaine, methamphetamine, and excessive phenylephrine use

Rx is largely supportive, although if there is no severe cardiac failure and no hypotension, beta adrenergic blockers may be of use
those with a LV mural thrombus will require anticoagulants

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