'Broken-heart syndrome'… Be aware..

Abstract

Takotsubo cardiomyopathy (TCM), also known by various other names such as broken-heart syndrome, stress-induced cardiomyopathy and apical ballooning syndrome, is an acute, reversible, transient left ventricular dysfunction that was first described by a Japanese cardiologist in 22 patients in the year 1990. The Japanese word ‘takotsubo’ means an octopus trap, used to describe the shape of the left ventricle in this condition during systole. Since its original publication, there have been several case reports describing its occurrence in patients in the periprocedural and perioperative periods, underscoring the importance of the need for awareness about this rare syndrome among anaesthesiologists. There are several case reports published from India too. In this issue of the Indian Journal of Anaesthesia, a case of this entity is reported after thyroidectomy and also one describing its occurrence in a young patient who developed anaphylaxis to cephalosporin intraoperatively during limb salvage surgery for osteosarcoma of the tibia.[1,2] TCM is more common in elderly postmenopausal women, although presentations have been reported in young men and women also. A systematic review of this syndrome has recently been published by Ono and Falcao.[3] The triggering factor for this cardiomyopathy seems to be the elevated levels of plasma catecholamines due to physical or emotional stress, which leads to coronary spasm, direct myocardial toxicity or microvascular impairment. Iatrogenic administration of catecholamines can also be a trigger of this syndrome.[4] Lyon et al. have described a novel pathophysiological hypothesis to explain the myocardial stunning due to catecholamine excess.[5] It has been proposed that apical ballooning could be due to the abundance of beta receptors in this region that can lead to negative inotropy due to change in the intracellular signal trafficking. The Heart Failure Association of the European Society of Cardiology has recently published a position statement on takotsubo syndrome that includes a diagnostic algorithm comprising seven criteria including anatomic features, electrocardiogram (ECG) changes, cardiac biomarkers and reversibility of the ventricular dysfunction.[6]