Professor Juan Carlos Kaski, Director of the Cardiovascular and Cell Sciences Research Institute at St George’s University of London, UK, discusses the mechanisms of takotsubo, and the outlook for patients with this condition, during the ESC2015 Congress in London, UK.
Takotsubo is a form of myocardial ischaemia affecting a very large area of the myocardium in the absence of coronary artery disease.
The name takotsubo derives from the fact that the morphology of the left ventricle at angiography when these people are affected by the condition takes the shape of a flask that the fishermen in Japan use to catch octopus. So the heart looks very much like an octopus flask of these fishermen.
It is a very important condition and its very important to recognize it. It actually affects a large area of the myocardium. It is triggered mainly by emotion. In most of the cases described in the literature are linked to an event that has been pretty serious psychologically – bereavement, being mugged in the street, those kind of events that make individuals pretty anxious – that is the most common trigger.
And the mechanism is very interesting as well, because patients with takotsubo have major problems with the blood flow going to the heart because the micro vessels are shut down by the excessive release of catecholamines during the emotional stress. This is one of the most common causes. There are other reasons why people develop takotsubo, but this is the most common reason.
And it has good prognosis. It requires treatment, as any acute myocardial infarction, except that you don’t need to do an angioplasty because there are no obstructions to the arteries. So the patient will be required to be monitored in a CCU, and gradually the function will recover. And one of the characteristics of takotsubo is the function of the ventricle – which is pretty awful initially – will gradually recover over a few months, so the prognosis is quite good.
But I think cardiologists around the world have found ways of identifying this condition and making a proper diagnosis.