Takotsubo syndrome, often called “broken heart syndrome”, is a temporary cardiomyopathy that usually occurs in response to intense emotional or physical stress. It manifests as a sudden, reversible weakening of the heart muscle.

 

The symptoms of Taktsubo are the same as those of a “classic” heart attack. They may include chest pain, tightness, pain in the jaw or left arm, shortness of breath at rest or on exertion, severe fatigue, palpitations, nausea or vomiting, malaise.

 

These acute symptoms should prompt you to call 15.

In most cases, this syndrome is benign, and patients recover completely within a few weeks. However, in some cases, serious complications can arise, including :

- Acute heart failure (the heart is too weak to pump enough blood).

- Severe arrhythmias, which can lead to cardiac arrest.

- Cardiogenic shock, where the heart is unable to supply enough blood to vital organs.

- Rarely, rupture of the ventricle wall, a fatal complication.

 

To find out more:

The cause of Takotsubo syndrome is not fully elucidated, but mainly involves transient myocardial dysfunction linked to abnormal neurohonal responses to stress.

​

The various hypotheses are:

1. Hyperactivation of the sympathetic system

In the event of intense emotional or physical stress, the sympathetic nervous system is over-activated, leading to a massive release of catecholamines (adrenalin and noradrenalin). These catecholamines act on the heart's beta-adrenergic receptors, causing :

- Coronary vasoconstriction (reduced blood flow to the myocardium).

- Direct myocardial toxicity (excessive inotropic effect).

- Imbalance between myocardial oxygen supply and demand.

​

2. Impaired myocardial contractility

Catecholamines induce regional myocardial dysfunction, mainly in the apex of the left ventricle (hence the “octopus pot” or “takotsubo” shape in Japanese). This hypokinesia or akinesia of the apex is associated with compensatory hyperkinesia of the base of the left ventricle. This leads to an overall reduction in systolic function.

​

3. Dysfunction of coronary microvessels (microangiopathy)

Endothelial dysfunction in small coronary arteries has been observed in some patients. This microangiopathy may contribute to transient myocardial ischemia, without visible obstruction of the large coronary arteries on angiography.

 

4. Hormonal factors (role of estrogen)

Takotsubo syndrome mainly affects post-menopausal women (around 90% of cases). The decrease in estrogen after menopause may alter the cardiovascular protection normally conferred by these hormones, increasing susceptibility to the deleterious effects of catecholamines.

 

5. Transient myocardial inflammation

Some studies suggest that intense stress can induce myocardial inflammation, with infiltration by inflammatory cells and release of pro-inflammatory mediators, aggravating myocardial dysfunction.