According to a recent article in the Nursing Center of the Advanced Emergency Nursing Journal, Takotsubo Cardiomyopathy (TC) is a rare syndrome that mimics ST-segment elevation myocardial infarction (STEMI). This is the term cardiologists use when describing a classic heart attack. The flat section of an electrocardiogram is referred to as ST and represents the segment between intervals on the ECG. During a heart attack, ST no longer appears flat but will appear abnormally elevated.

The two main types of cerebrovascular accident are the

• Ischemic stroke caused by a blockage
• A hemorrhagic stroke caused by a rupture in a blood vessel.

In both types, the brain is deprived of oxygen and blood, resulting in the death of brain cells.

About TC

TC is a temporary and reversible systolic abnormality of the left ventricular apical (apex) area where blood flow to a part of the heart muscle (myocardium) has been obstructed. This results in the death of that portion of the heart muscle.

TC is suspected of being set off by a physical or emotional trigger and is therefore called the broken heart syndrome. It was discovered in 1990 and named Takotsubo or octopus pot due to the pot’s bulging shape resembling the partial ballooning of the heart’s lower left ventricle (apex).

TC has a four to five percent mortality rate. The disorder mostly affects postmenopausal females (90%). Patients typically appear in the emergency room with chest pain and labored breathing (dyspnea).

Doctors have difficulty distinguishing between TC and STEMI when testing on an ECG. It is therefore recommended that all such patients have a coronary angiography with a left ventriculogram test showing images of the heart. The test lets the doctor check the lower chambers of the heart (ventricles) and how well the heart is pumping. Cardiac magnetic resonance imagines (MRI) and echocardiography diagnostic studies are also recommended.

Other Causes

Emotional trauma is not the only probable cause of TC. Several cases have emerged where energy drinks or antidepressants are the suspects.

For example, a twenty-four-year-old patient was admitted to the emergency department with chest pain that radiated to his left arm. He complained of nausea and had trouble breathing. The patient had no significant medical history, did not smoke, and had no history of cardiac disease nor did his family.

The patient did, however, admit to being under significant stress from managing two jobs. He said that he relied upon several energy drinks each day to remain alert.

Doctors obtained an ECG showing ST elevation with the patient meeting STEMI criteria. He was given TNKase which is an FDA-approved drug used in the treatment of acute myocardial infarction. The TNKase acted immediately to ease symptoms.

The patient was airlifted to a nearby cath lab (catheterization laboratory) where his cath lab results showed no obstructions or calcification. The patient was discharged with low-dose aspirin, a beta-blocker, and a low-dose ACE inhibitor that lowers blood pressure by relaxing arteries and veins.

The patient’s discharge diagnoses indicated apical hypokinesis, which is a pulmonary hypertension marker of right ventricular dysfunction, and left ventricular hypercontractile function due to “drinking substantial amounts of Red Bull.”

Similar cases have been recorded due to dependence upon antidepressants, such as selective serotonin-norepinephrine reuptake inhibitors and reuptake inhibitors.

Diagnosis, Treatment, and Discharge

Several studies have suggested various ways to diagnose TC as opposed to an anterior STEMI, but an ECG alone cannot accurately diagnose TC.

There are no previous studies that outline an appropriate treatment type. Data to support discharge treatments are limited.

In conclusion, TC should be included in a diagnosis but an ECG is not to be considered definitive. Treatment that includes thrombolytics or cardiac catheterization should be considered immediately. An MRI may help determine TC or other causes of ST elevation.

TC complications include cardiogenic shock, arrhythmias, and ventricular rupture. Treatment generally includes an ACE inhibitor or ARB with the intent to restore left ventricle function.