Abstract 13114: Beyond the Medical Record: An In-Depth Exploration of Takotsubo Syndrome Triggers

Abstract

Introduction: Takotsubo syndrome (TS) is an acute, reversible episode of systolic dysfunction, preceded by emotional/physical triggers in 2/3 of cases and no trigger in 1/3 of cases based on retrospective medical record data. Research Question: How do patients with a recent TS episode describe their triggers? Goals: To conduct an in-depth investigation of patient narratives concerning the events that triggered their TS episode. Methods: We conducted semi-structured interviews in patients with a recent (< 1 month) TS episode (Mayo Clinic criteria). We inquired about (1) type of trigger(s), and (2) trigger timing (< or > 48-96 hours before TS episode). Triggers were coded as emotional, psychosocial, and/or behavioral/physical. Recordings were transcribed, coded, summarized, and analyzed by the first and second authors. Results: Over 2/3 of patients (n=30; 97% female, 93% white; age 64 ± 9 yrs old) identified a trigger. Triggers included: a) acute events that occurred <48-96 hours before the TS episode (e.g., death of daughter), b) chronic circumstances that occurred both outside of and within 48-96 hours before the episode (e.g., conflicts with spouse), and c) acute events that occurred >48-96 hours before (e.g., binge drinking). The most prevalent triggers were negative emotions (86%; e.g., stress) and behavioral or physical factors (81%; e.g., atypical exercise/exertion). Nearly all triggers reported (81%) were multi-factorial (e.g., both physical and emotional). Of note, among participants who initially did not identify a trigger, 67% described potential triggering factors during the interview (e.g., increased stress). Conclusions: Consistent with the literature, 2/3 of patients identified a trigger. Yet, in contrast with current evidence, triggers were most often multifactorial (e.g., both emotional and physical) and many were chronic/ongoing. Moreover, for participants who could not identify a trigger, a potential trigger was often identified in the interview. Patients’ narratives around TS triggers are highly complex and likely insufficiently captured in clinical encounters. If these findings are replicated in larger and more diverse samples, they could lead to a re-thinking of the role of triggers in the onset of TS.