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Un-Break my heart! Save me from Takotsubo!

One of the favorite questions for all examiners in the medical field and you will see it in your exams frequently. Stress induced cardiomyopathy, also known as "Takotsubo" or "Broken heart syndrome" or "apical ballooning syndrome", is a type of non-ischemic cardiomyopathy which is thought to be caused by physical or emotional stress. It was first described in the 1990s in Japan and that's how they called it "Takotsubo", which is an octopus trap in Japanese. As the name implies, the heart in this condition looks like the octopus trap.

We are recognizing this condition more and more every day. Always think about it whenever a patient presents with troponin elevation and ECG changes. Cardiac catheterization will be negative for significant disease that would explain such weakening of the heart muscle. On echocardiogram, they describe the base of the heart as hyperkinetic but the apex is hypo- or akinetic, which are pathognomonic.

So far we don't know what causes Takotsubo, but some theories suggest either vasospasm, microvascular dysfunction or catecholamine induced myocyte injury as the cause. Few patients die from Takotsubo though the majority regain cardiac function after appropriate medical therapy.

One of the interesting quotes comes from a novel where a village girl suddenly dies after a handsome lawyer asks her out. At this girl's funeral, her father states that she was never healthy and was born with a heart defect. Her mother said: "She died from happiness".

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