Take a elderly woman who recently lost her husband suddenly. A couple days later she develops acute shortness of breath and chest pain. She dies while being assessed by EMS technicians. No autopsy is performed and the presumed cause of death is cardiopulmonary arrest secondary to coronary artery disease. The most common cause of death in the United States, and reasonable given the clinical scenario. But perhaps her loved ones are more accurate than the pronouncing physician, when they say she died of a broken heart...
Takotsubo cardiomyopathy is a particular type of non-ischemic dilated cardiomyopathy with certain pathophysiologic features. Individuals with this cardiomyopathy are more often women who present with a sudden chest discomfort that occurs in the sequelae of a sudden emotional stress. The initial presentation often mimics an acute anterior wall myocardial infarction, with typical EKG findings of ST elevation in the precordial leads, and cardiogenic shock, with hypotension and congestive heart failure. At the time of cardiac catheterization, the coronary arteries will generally be normal, with ventriculography revealing a hyperdynamic base of the heart and a dyskinetic apex, which balloons out with each ventricular contraction.
These clinical features have given rise to it also being known as transient apical ballooning, stess-induced cardiomyopathy, and, in the popular press, broken heart syndrome.
