Study offers closer look at Takotsubo cardiomyopathy

"Broken heart syndrome" is still a mystery to many in the medical community, but new data from researchers at The Miriam Hospital may shed some light on the clinical characteristics and outcomes of this relatively rare, life-threatening condition.

Researchers created a registry of 70 patients with the syndrome, known medically as Takotsubo cardiomyopathy, who were diagnosed between July 2004 and April 2008. Two-thirds of the patients - almost all post-menopausal women - had experienced a very stressful physical or emotional event just before arriving at the hospital with heart attack-like symptoms. Although 20 percent were critically ill and required emergency treatment to keep them alive, all patients survived the first 48 hours and experienced a full and complete recovery,

The report is published in the April 1 issue of the American Journal of Cardiology .

"It can be difficult for cardiologists and emergency room physicians to diagnose and manage patients with broken heart syndrome. However, this data will helps us better understand the disease process and could play a major role in developing and tailoring more effective short and long-term treatment strategies," says lead author Richard Regnante, MD, an interventional cardiology fellow at The Miriam Hospital and a teaching fellow in medicine (cardiology) at The Warren Alpert Medical School of Brown University.

Broken heart syndrome was first described by Japanese researchers in the early 1990s. Symptoms typically mimic a heart attack and tend to follow exposure to an intense physical or emotional event. Experts believe these symptoms may be brought on by the heart's reaction to a surge of stress hormones, like adrenaline, causing a part of the heart to temporarily weaken or become stunned (cardiomyopathy), although the exact mechanism is unknown. However, it appears that broken heart syndrome is temporary and completely reversible.

All patients in the Rhode Island Takotsubo Cardiomyopathy Registry arrived at the hospital with heart attack-like symptoms, including chest pain and shortness of breath. Because of those similarities, patients underwent emergency cardiac catheterization. Approximately 67 percent of patients had been exposed to some sort of physical or emotional distress - such as bad news about a family member, a domestic argument, severe physical illness or a car accident - just before the onset of symptoms. All were eventually diagnosed with broken heart syndrome during their hospital stay.

Researchers identified a wide spectrum of disease severity among patients in the registry. Six patients presented with cardiogenic shock and three patients experienced sustained ventricular arrhythmias, requiring emergency defibrillation or cardioversion. Overall, the majority of those in the registry were prescribed aspirin, beta blockers, ACE inhibitors and statins during their hospitalization, consistent with treatment protocol for patients with acute coronary syndrome. Similarly, most patients left the hospital on a cardiac regimen very similar to that prescribed for heart attack patients.

Looking at long-term prognosis, researchers say patients tended to do well from a cardiac standpoint, with only two patients experiencing a recurrence of broken heart syndrome, while the remaining patients did not appear to have any other cardiac issues during the four-year follow-up.

"Although there is much we're still learning about broken heart syndrome, we do know that it is rarely fatal as long as patients are fully supported with medications, respirators and other critical devices in the first 48 hours," says Regnante.

The registry also revealed an interesting and unexpected discovery that researchers say is not easily explained: the majority of broken heart syndrome cases occurred during the spring and summer months. Regnante points out that this is in complete contrast to the seasonal timing of heart attacks, which tend to occur during the winter months, and says this finding fuels the debate about what actually causes the weakened muscle in broken heart syndrome.

"Some believe it is simply a form of a heart attack that 'aborts' itself early and therefore doesn't leave any permanent heart muscle damage. Others say that the syndrome has nothing to do with the coronary arteries and is simply a problem with the heart muscle," he says. "Since the seasonal pattern of broken heart syndrome that we observed is opposite of what it seen with heart attack patients, our findings suggest - but certainly does not prove - the latter theory may be correct."

As a next step, Regnante and colleagues are currently enrolling patients with broken heart syndrome for a new study in which intravascular ultrasound (IVUS) will be used during cardiac catheterization. This imaging technique can uncover evidence of ruptured plaque in the artery or a small blood clot, which happens when a patient suffers a heart attack, but cannot be seen well on angiography alone. Researchers say this important study may help answer the ongoing question about the mechanism that causes broken heart syndrome.


  1. Elite Health Elite Health United States says:

    Exercise has been really a very important factor for the people of today’s generation. And especially exercise really helps heart patient more than anything. I have got an enlarged heart because of inability of pumping. I was also having a defective valve, which led me to be a sinus tachycardia patient. I got to know at my medical checkup at my campus. And being very young to face all this, I was really frightened regarding all these health issues. I need someone to monitor my health and keep an eye on my health as well as daily health issues. Getting an internist hired was just not the solution to the problem. I got to know about some kind of wellness program from elite health ( Medical Service Provider Company. I got enrolled in it, as they were providing me 24/7 access to the doctors. Especially, I got one unexpected and quite a surprising opinion from their health executive who used to monitor my health and guide me the appropriate dietary solutions. He told me to have a regular exercise daily. I thought he is really mad, or planning to kill me. Ha Ha. .. But my regular exercise! Not so heavy, the results came out to be positive. I was really feeling better and healthier as compared to previous conditions. So, indirectly, exercise has really helped me suppress my health issues, especially the problems we generally face while having heart failure.

  2. Pam Pam United States says:

    I am recently recuperating from takotsubo cardiomyopathy, an illnesss that mimmics a heart attack, but is believed to have nothing to do with blocked arteries.  The heart muscle walls are affected, ususally left ventricle, with varying differences in the T and Q waves shown on the ECG.  This illness was discovered in the early 1990's in Japan.  Its name means broken heart or octopus and is referred to octopus traps. I was hospitalized twice within the past three weeks and am on day no. 6 at home.  This illness is due to the heart producing toxins, too much adrenaline/norepinepherine, which in turn damages the heart muscle and is stress related.  Most patients recover 100% although there can be recurrence within the first four years.  It can take several months to recover.  I have learned quite a lot online.  Exercise has become a part of my daily regiment.  The guidelines for treatment include low salt and sugar diet.

    • angela angela United States says:

      I am recuperating from the same as you Pam.  My attack happened on 9/23.  Two weeks at home and I am feling better.  I have occasional 'pings and pains' in my chest and down my left arm, but I TRY to not let that worry me.  I'm on several medications and while my hope was that once I am 'cleared' in another 3 weeks or so, No more meds.  HOWEVER, the more I read online (even though information is minimal) it seems most people are staying on the meds long term.  I have not added any salt to my foods for the past 2 weeks, but this is the first that I have heard about low sugar.  Would you like to share some of the websites you have found?
      Take care!

  3. Sandi Sandi United States says:

    I have experienced 2 episodes, 4 years apart. The most recent in January this year.  While the first was after an extended period of stress, the second was not, and both were actually triggered by physical activity that included bending and pulling. I continue to have days with what I've come to interpret as warning symptoms and have learned to lay low because I can actually start things up if I ignore them.  Other days I can do anything I want without a problem. I wonder if anyone else has experienced anything like this?      

  4. chris chris United States says:

    My heart attack occurred Oct. 14th. I am 46 and very healthy.  It is nice to read what has been by other people.  I am so tired. I thought it was me, but now I am wondering if it is the beta blocker.  My MD cut the dose in half.  Did anyone do cardiac rehab?  I just want to get back to work and active again.  At night when I lie in bed, it is as if my heart is pounding in my head and just a slight heaviness in my chest. I am wondering how long before it is life as usual?

  5. J Charmer J Charmer United Kingdom says:

    I was rushed into hospital with a suspected massive heart attack, symptoms soon subsided and I was admitted into hospital and put on the cardiac unit on the 21st November, 2008.  I was taken down the next day to have a vein put into my heart where I was told that my arteries were all perfectly healthy but was diagnosed with Broken Heart Syndrome. Although the specialist himself diagnosed this the actual Doctors dealing with me didnt seem to have much clue and continued to advise me that I had a heart attack. I was on all medication that is given to heart attack and indeed they made me feel pretty unwell for several months later.

    Since this I attended Cardiac rehab, although was told later by the specialist that it would benefit me mentally but I didn't really need it as I did not have a specific heart disorder like heart decease.....since I was only 48 at the time, I attended this class with mostly elderly men but it was fun and I learnt alot about the heart that I was not aware of, such as eating and exercise.  
    I went to the Specialist in April, 2009 and had several checks and was told my heart had totally repaired and to go away and live a healthy life.......good news, as apart from a 75mg Aspirin and a statin that is all I have to take now.
    I has stressed out at the time of having this attack and I am menopausal, having hot flush etc., I have got on with my life and tend to put it at the back of my mind, sometimes I might have a little panic attack mainly because no-one seems to know much about it or the correct treatment. Its difficult when you are enquiring about insurances etc., because it dosent seem to be recognised, infact having to take the laughter and sighs when they hear you have Broken Heart syndrome and not a Broken Heart dosent allow you to get to serious about the condition.

    I would like to know more, I have searched the internet and every site going, my Doctor knows very little but said after reading the Specialists notes that I had nothing to worry about and that also helped with my general well-being.  

    I was told it rarely happened twice so was surprised to see that it has, I will be a little bit more aware of that now in the future.
    All in all, it was a terrible event to go to and I wouldnt wish to have it again, it would be great to know more and it was lovely to read your individual experiences.

    • Cecilia Cossote Cecilia Cossote United States says:

      J Charmer, I just found this for insurance codes at wikipedia for Takotsubo Cardiomyopathy.

      ICD-9       429.83

      DiseasesDB  33976

      MeSH        054549

    • sajarn sajarn United States says:

      I too had Takotsubo Syndrome or Broken Heart Syndrome when I was 42 years old.  I am an RN and was lucky to have been life-flighted to a trauma center 30 miles away and lucky to have been placed with a cardiologist who suspected Takotsubo myopothy at the time.  The other doc's told me I had a massive heart attack when I awoke froma coma 10 days later but were confused because I had no heart damage.  Let me say also that I had a physical with blood work 2 weeks before the occurrence with a clean bill of health. I was transferred to the place where I was a Unit Manager at the time of occurrence and had intense physical therapy and was back to work 3 months later cause that's what I needed to do to support my family.  (I am a divorced Mom) and started with only 2 days a week then quickly went to full time again because it is what it is.  It will be 8 years in November and I now find myself faced with other issues and will be evaluated by a neurologist on June 3rd to rule out a movement disorder ( Parkinsons, etc).  I would love to hear from other who have experienced this and Good Luck to you friend, Sandy

  6. amy amy Australia says:

    I was recently digonsed with "broken heart sydrome" I am 22 years old Im from Ireland, there is still no answer given to am as to why or how I develpoed this condition. It's a big burden on my life as I am very into my sports and keeping fit. Your opinion would be greatly appericated. Amy

  7. nicole nicole United States says:

    I was 23 when I had my episode and was diagnosed. honestly I don't remember feeling much pain. I had just come home from having lung surgery ( I had had a spontaneous numo thorax 2 months prior) I was still on pain meds. but I was in my car and driving and blacked out. when I came to I was in the hospital but unaware of my surroundings. my sugar also sky rocketed to 500... but I haven't ever had problems with my sugar before or even now. anyway.. with in weeks my heart went right back to as before. I was 6 months post partum as well. I was wondering if anyone had been told anything on having future pregnancies?

  8. Phyllis Phyllis United States says:

    I took penicillain for sinus infection within 15 minutes I was fighting for my life. This put such a stress factor on my heart,I couldn't get my breath all vitals were practically gone. They revived me in the ambulance. So yes maybe stress but watch the meds you take too. They say I will go back to normal and yes I do still have pains in my heart. I have been under some stress but not that much so who really knows. Just stay close to the Lord because you never know. And yes when they put in the balloon I could see black things like grabbing my heart like tenticles they placed a balloon over these this was to smother the tenticles,it was really scary. So any information that people can give on this can maybe save some ones life.

  9. Kim Kim United States says:

    I have been diagnosed with Takotsubo and find the lack of information on the disease very disturbing.  Pretty much the doctor said you have Takotsubo, take these meds and go home.  After only two weeks I was released to return to work full time and I am exhausted.  My blood pressure drops really low, my heart bumps around, I have chest pain, short of breath and of course worry about what is going on.  This began with severe chest pain for which I was hospitalized and like others there seemed to be a lot of confusion as to what was wrong.  To the medical staffs surprise I had a heart attack the next day.  This pushed them into doing a heart cath and as soon as the doctor saw the left ventrical he announced Takotsubo.  I just wish some time was spent on explaining to me what I should expect to feel during this period of time, how do you know if there is something you need medical care for?  

  10. joni ellerbrock joni ellerbrock United States says:

    I had my tako tsubo on 8/1/2011.  I am an RN and knew I was having a heart attack, but also knew it wasn't a "normal" one.  It has been almost a month and I haven't seen the cardiologist for follow up yet and still am on heart meds.  I agree with others that the meds seem to keep me tired.  The shortness of breath is bad which limits my activities.  I have started gaining weight and would really like to know if anyone has heard or been told about how to get back to 100%.  As others say, I was treated as though I have heart disease (which I do not).  I don't want to take meds, especially if they aren't helping.

    • Jan French Jan French Australia says:

      I was diagnosed with TS  a few days after being hospitalised with chest pain.  It is now 5 weeks since then and the meds that I am on are making me extremely tired.  It is very frustrating not to have much information on the condition and, like Joni, I wonder how long it will be before I am back to feeling normal.  I have been told that there is a slight possibility that the left ventricle muscle may have suffered permanent damage as a result of this event but the angiogram determined that I do not have blocked arteries.  I will be seeing the cardiologist for follow-up in about two week's time.  In the meantime all I can do is take short walks, meditate, paint and draw, rest, read and rest some more.  
      I'd be interested to hear how long it has taken others to get off the meds, onto a sensible exercise programme and back to feeling well.

  11. Sarah Dowds Sarah Dowds Australia says:

    I had Takotsubo cardiomyopathy in January 2008 after a family argument.  Went to emergency department, was admitted immediately and diagnosed initially with a STEMI - a heart attack.  Was taken to Cath Lab and had an angiogram within two hours of admission.  Told it was not a heart attack, but was Takotsubo cardiomyopathy/stress cardiomyopathy and that it was reversible and I would have no heart muscle damage.  Spent three days in Coronary Care and discharged on medications which I still take.  I returned to fulltime work on light duties after two weeks, and full duties after a further two weeks, was reviewed by cardiologist after six weeks and pronounced recovered with my injection fraction being back to normal.  Have had two more cardiology checkups, two years apart, and have been well ever since.  I retired three years ago and am now 65 years of age.

  12. Mimi Dempsey Mimi Dempsey United States says:

    Wow, even though many of these posts are older, for the first time since I had my takotsubo heart attack (the docs did call it an actual heart attack) I'm reading something that sounds like me. I  am 54 and have no heart disease and was in peak condition when this happened on April 11 this year. In fact I was backpacking in the mountains when it happened. However, I had had similar episodes for several months before the worst one which I knew I had to get the the ER for. They found no blockages at all but part of my heart was not pumping properly (the opposite for most taktosubo cases). I was given meds and told I would be back to normal in one month. For the most part I feel well except when I don't feel well. I do feel tired but now I'm thinking this could be from the beta blockers or the other medicine a blood pressure one. I do not have high blood pressure, nor did I ever, I guess it is just customary to give this for takotsubo patients.  I just wish I knew what to expect in the future. I am dealing with some anxiety as well as post trauma stress from the event itself which was very scary. My job is rather rigorous but I love it and I'm just not back 100% yet and it has been almost one month. I would love to chat with anyone who has any insight on this as there is little still online to go by.

    • Ann Warner Ann Warner United States says:

      Mimi, I am wondering how the past year went for you. I am 4 weeks out from my episode and feel there is a huge lack of info about recovery and what to expect. Any update about your recovery?

      • Denise Otten Denise Otten Canada says:

        I am so glad to have found these posts even if they are quite dated.  It is three weeks since I had my "event" and I am finding the lack of info frustrating.  Last night I experienced chest pains and my blood pressure was very low again.  Was not sure what to do - I felt that if I go back to emergency they will not take it seriously. I was in hospital for three days but after I had an angiogram and Takotsubo was diagnosed they basically released me with very little advice about what to expect during recovery.  

        It seems from previous posts that chest pains are to be expected.  I was also told that it will go away in 3 months and it won't happen again bit that does not appear to be true.  Will take it by easy until I see the cardiologist in 5 weeks, but am a little scared right now.

        • Dee Matthews Dee Matthews United States says:

          I am repeating probably, but not knowing any "definites", is the worst.  First day of spring 2017 (March 20) I had takotsubo, but I don't remember much besides very sudden and severe nausea/vomiting  for several minutes before going to the ground and passing out. I was taken to the local hospital and then airlifted to a bigger hospital as they realized they did not know what to do with me. The heart doc knew immediately & they kept me in ICU for several days.  I "woke up" at some point & was confused of course as I had no history of heart issues, non-smoker, not overweight, etc. I am still confused as to what I should or should do as the doc just said..."do as tolerated" ?

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