Why do we often associate this heart disorder with losing a loved one?
If you look at people who present this way, about 80% have experienced an emotional or physical stress in the hours or days preceding their presentation. Emotional stress can take lots of different forms, but losing a loved one is certainly one of them. The first case I ever saw was somebody who witnessed their son get hit by a car. Physical stress can also play a role.
Is this cardiomyopathy treatable?
Yes. A therapy that is generally used is to put people on betablockers, which reduce the energy costs of cardiac contraction, and that seems to facilitate recovery.
How does it differ from the other types of cardiomyopathy?
People who have heart attacks develop a cardiomyopathy, and the difference between this and those is that in the takotsubo population, the coronary arteries are perfectly normal, and in people who develop heart attacks, the coronary arteries tend to be narrowed. There is a whole spectrum of other types of cardiomyopathy. But the difference is that this largely recovers and a lot of the other kinds of cardiomyopathies are not so forgiving.
What is the connection to women?
Nobody completely understands why, but about 90% of the people who get this are women. It may be linked to estrogen, but we haven’t figured that out.
Could the disorder be underdiagnosed?
I have no doubt there are people in the world who have emotional stress, get chest tightness in the setting of the emotional stress, and feel crummy for a week or two afterwards and don’t seek medical attention. And if those people do come to see me maybe a month after the fact, their hearts may be perfectly normal, and I wouldn’t be able to tell them whether or not they had this transient heart dysfunction.
Could delayed diagnosis lead to poorer outcomes?
Bad things could happen in the acute setting if your heart is not working. You could develop electrical instability. You could develop worsening heart failure, and there could be bad outcomes. The world, sadly, is full of people who just drop dead, and we don’t know why. And I have no clue if that group of people falls under this umbrella or not. In general, if you are having chest pain and can’t breathe, you should see somebody.
Has there been an increase in cardiomyopathy since the COVID-19 pandemic hit?
Yes. There was one study published, and one study is only one study, but they surveyed people who came through a couple of very busy cath labs. Normally, the percentage of patients with what was presumed to be a heart attack included about 2% of people who had takotsubo. During the spring spike in COVID in March, April and May, when they surveyed what came through the cath labs, it was about 8%. So, relatively speaking, a big increase.
Have you observed an increase in the clinic?
We’ve seen it anecdotally. The general impression within the community at large is that this is happening with an increased frequency over the past year. These have been stressful times.
What else have we learned about this rare disorder?
In the last few years, people have been really trying to assemble larger case series so that they can be more systematic about evaluating what are triggers and what tracks most effectively with recovery. One of the things that would be nice to know is who is truly at risk. We don’t know very much about the substrate except that it’s women, which is not really very specific. You are slightly more than half the population, so that doesn’t really help all that much.
Do you know of any related research on the CU Anschutz campus?
There has been a lot of work over the years on how catecholamines cause myocardial muscle damage. And the investigators on this campus were among the first to say that the use of this class of drugs called beta-adrenergic blockers, drugs that block the effects of catecholamines, facilitate cardiac muscle recovery in a spectrum of cardiomyopathies.
What else can you tell us about takotsubo syndrome?
Everybody in the entire cardiac community is infatuated with the name takotsubo, so one of the lessons is if you attach a cute and interesting name to a syndrome, you suddenly get attention. And I get asked about it every February. But that’s OK. I’m happy when people are writing stories about heart disease.