Is there a “chronic Takotsubo syndrome”? Could “smart-phone”-based technology be of aid?

Abstract

Reviewing the literature one encounters case reports of patients with recurrent Takotsubo syndrome (TTS), in whom the recurrent episodes are separated by months or years [ [1] http://www.ncbi.nlm.nih.gov/pubmed/?term=takotsubo (accessed last 3/19/15). Google Scholar ], or who had more than 2 episodes of TTS [ [2] Lagan J. Connor V. Saravanan P. Takotsubo cardiomyopathy case series: typical, atypical and recurrence. BMJ Case Rep. Mar 5 2015; (pii: bcr2014208741)https://doi.org/10.1136/bcr-2014-208741 Crossref PubMed Scopus (4) Google Scholar ], or who had one admission with TTS during which they experienced recurrent attacks of chest pain and/or dyspnea separated by quiescent time intervals of several hours, with parallel perturbations of the electrocardiogram repolarization changes [ [3] Sinha A. Rassiwala J. Goldschlager N. Takotsubo cardiomyopathy: how T waves behave under stress. JAMA Intern. Med. 2015; 175: 842-844 Crossref PubMed Scopus (3) Google Scholar ]. Some of these patients with such atypical clinical TTS are reported as having “intermittent substernal chest pain for the past few months that had worsened in the past weeks”, that culminated in an admission with documented TTS [ [3] Sinha A. Rassiwala J. Goldschlager N. Takotsubo cardiomyopathy: how T waves behave under stress. JAMA Intern. Med. 2015; 175: 842-844 Crossref PubMed Scopus (3) Google Scholar ]. Some other patients, particularly women with chronic stress, report during their single admission for TTS, that they had experienced occurrences of chest pain and/or dyspnea many weeks, months, or even years, prior to their documented TTS episode, were previously diagnosed as having angina, but found during their admission with TTS not to have obstructive coronary artery disease [ [2] Lagan J. Connor V. Saravanan P. Takotsubo cardiomyopathy case series: typical, atypical and recurrence. BMJ Case Rep. Mar 5 2015; (pii: bcr2014208741)https://doi.org/10.1136/bcr-2014-208741 Crossref PubMed Scopus (4) Google Scholar ]. In taking the history of a woman admitted recently with TTS, the author was told that the patient was often troubled with chest pain and dyspnea, for which she took to bed for hours to days at a time. Also he has noted that some patients, discharged after an admission for TTS, continue to complain of symptoms as the above, during their clinic follow-up appointments, and this is also reflected in the literature [ [2] Lagan J. Connor V. Saravanan P. Takotsubo cardiomyopathy case series: typical, atypical and recurrence. BMJ Case Rep. Mar 5 2015; (pii: bcr2014208741)https://doi.org/10.1136/bcr-2014-208741 Crossref PubMed Scopus (4) Google Scholar ].