Takotsubo cardiomyopathy (broken heart syndrome)
A sudden weakening of the heart’s main pumping chamber, often after intense emotional or physical stress, that looks like a heart attack: chest pain, breathlessness, changes on the ECG. On scans the chamber balloons into a shape like a Japanese octopus pot, which gave it its name.
What drives it
It shows how a shock such as a death can hit the heart itself, which gives the phrase ‘broken heart’ a literal case. Useful for identification because chest pain in grief can be read as ‘only emotional’, and this is one of the conditions that only medical tests can rule in or out.
How it shows
Work
A woman in her sixties gets chest pain at her desk two days after her brother’s funeral, and the ambulance crew treat it as a heart attack.
Relationships
Family expect the hospital to find a blocked artery and are told the arteries are clear but the heart is stunned. Arguments afterwards about whether ‘the stress did this’.
Self
Notice chest pain, breathlessness or fainting after a shock. These are body signs, and no amount of reflection can tell them apart from a heart attack.
What tells it apart
Panic: A panic attack can bring chest pain and breathlessness too, and it usually peaks within minutes. From the inside the two may feel the same, and only an ECG, blood tests and scans tell them apart.
Widowhood effect: Widowhood brings a rise in deaths from many causes across a population over months. Takotsubo is one acute heart event in one person, more likely in older women.
Somatisation: Somatization is distress expressed as body symptoms with no damage found. In takotsubo the change in the heart shows on scans, even when the trigger may be emotional.
A test
This one is answered by doctors, and reflection cannot settle it. As a hypothesis: chest pain soon after a shock, with clear arteries on angiography and a ballooned chamber on imaging, is more likely takotsubo than a blocked artery.
Questions to carry
- What happened in my body in the hours after I heard the news?
- When my body sends a signal, how quickly do I decide it is only stress?
Go deeper
- Read: The Other Side of Sadness, George A. Bonanno, 2009, revised 2019. Written for readers by a psychologist who has followed bereaved people for years. He questions the idea that grief moves through set stages and argues that most people come through a loss with more resilience than expected. Much of it rests on his own group's studies.
How strong the research is
strong. In 1,750 patients in the International Takotsubo Registry (Templin and colleagues, New England Journal of Medicine, 2015), 89.8% were women with an average age of 66.8, physical triggers (36%) were more common than emotional ones (27.7%), and serious in-hospital complications including shock and death were as frequent as in acute coronary syndrome. Heart function usually recovers within days to weeks, but the condition can recur and is not harmless. The mechanism is not settled, and a surge of stress hormones (catecholamines) is the main proposal. Separately, in 1,985 heart attack patients (Mostofsky and colleagues, Circulation, 2012), the rate of heart attack was about 21 times higher in the 24 hours after the death of someone significant.
Where it comes from
Sato and colleagues, Japan, 1990 (first report). Dote and colleagues, 1991 (named after the takotsubo, a pot once used in Japan to catch octopus). Templin and colleagues, International Takotsubo Registry, 2015