Takotsubo disease is a heart disease whose symptoms are very similar to myocardial infarction. Also known as broken heart disease, it is often caused by negative emotional shocks, but not only that. Women after menopause are the most affected.

Also called stress-related cardiomyopathy, apical bloating syndrome or broken heart syndrome, Tako-Tsubo syndrome has a Japanese name because it was first discovered in Japan. The term Takotsubo means octopus trap in Japanese and describes the particular shape of the left ventricular cavity in patients suffering from this condition. Transient cardiomyopathy, it usually lasts two weeks, in the absence of mortality.

With one in 36000 cases, it is a relatively rare syndrome, represented by 1 to 3% of patients suffering from the same symptoms as myocardial infarction.

There are clearly recognizable risk factors that may suggest Takotsubo syndrome:

• The patient is a postmenopausal woman with a significant drop in estradiol blood levels (estradiol seems to protect the microcirculation from the vasoconstrictor effect of adrenaline);
• The patient has a genetic predisposition, supported by the existence of familial cases;
• The patient has a history of psychiatric illness observed in 42% of cases (depression, anxiety, for example) or neurological (in 27% of cases, stroke, TIA, convulsions, for example).

Most targeted postmenopausal women

For some reason unknown to scientists, it is women over 50 who are most often affected by this syndrome (80% of cases). A hypothesis aimed at the post-menopausal absence of estrogen hormones, no longer protecting them from stress, could however explain their fragility vis-à-vis Takotsubo.

Causes linked to emotional shocks 

Because it is indeed stress and negative emotional shocks that would be the main triggers of this syndrome. Loss of a loved one, romantic break-up or even relationship stress, all associated with intense fatigue, are events that would greatly promote the onset of Japanese syndrome.

Takotsubo can be triggered by both negative and positive emotional shocks:

• Ruptures;
• Bereavements;
• Anger ;
• Anxiety;
• Financial problems;
• Geological shocks (earthquakes, floods, cyclones, etc.);
• Or even positive emotional shocks (wedding, birthday party, birth of a grandson or granddaughter, etc.).

In order to detect Takotsubo syndrome as quickly as possible, it is necessary to pay attention to the first symptoms which may first suggest a heart attack or an acute myocardial infarction: 

• sudden shortness of breath;
• chest pain ;
• loss of consciousness ;
• malaise vagal.

Also, the way in which the symptoms were triggered (following an emotional shock or not) and whether the patient is a postmenopausal woman, can directly suggest the broken heart syndrome.

It is advisable to act as quickly as possible in this case because a rapid diagnosis can avoid serious consequences on the heart and to manage the patient in an appropriate way. 

This syndrome is by no means a benign cardiomyopathy and justifies close monitoring by electrocardiogram until complete recovery of the heart.

The risk of recurrence is 5% within three years of the onset of the syndrome.

The management of a patient with this broken heart syndrome does not differ much from one with the more classic myocardial infarction. However, in order to guide their recovery as well as possible and to provide the most appropriate treatment, doctors have a rating scale that allows them to guide a diagnosis quickly.

It is a rapid diagnostic orientation tool, called InterTAK, which can be easily used in consultation.

It is based on 7 parameters:

1. Female gender (25 points);
2. Existence of psychological stress (24 points);
3. Existence of physical stress (13 points);
4. Lack of ST segment depression (12 points);
5. Psychiatric history (11 points);
6. Neurological history (9 points);
7. Prolongation of the QT interval (6 points).

A score greater than 70 is associated with a probability of Takotsubo syndrome equal to 90%.