Takotsubo cardiomyoathy, also termed 'stress cardiomyopathy' or 'broken heart syndrome' is a sudden weakening of the heart muscles, often in response to an episode of intense emotional or physical stress. The main pumping chamber of the heart, the left ventricle, weakens in a peculiar pattern, resulting in a shape like a Japanese octopus pot ('Takotsubo'), thus the name.

The exact cause of Takotsubo cardiomyopathy is unknown. Contributing factors will include:

• Female sex
• Post-menopausal status
• Sudden surge of stress hormones (from emotional or physical stress)
• Systemic inflammation
• Underlying psychiatric disorders
  

This condition often mimics an acute myocardial infarction ('heart attack'). The long-term outcome for this condition is generally good, with most patients recovering their heart function completely over time.

• Chest pain
• Shortness of breath
• Heart palpitations
  

Amyloid cardiomyopathy is diagnosed by cardiologists, by integrating various clinical information, including:

• Patient symptoms
• Clinical examination findings
• Blood tests
• Troponin levels: a protein released following heart muscle damage
• NT-proBNP: hormone produced by the heart, which is markedly elevated in heart failure
• Electrocardiogram ('ECG')
• Electrical tracing of the heart, often indistinguishable from a heart attack in Takotsubo cardiomyopathy
• Chest radiograph
• X-ray examination, looking for abnormal heart enlargement/ abnormal fluid collection in the lungs due to acute heart muscle weakening/ heart failure
• Coronary angiogram and left ventricular angiogram
• Invasive procedure to look for acute obstruction of the blood vessels of the heart
• A left ventricular angiogram can demonstrate the typical pattern of heart muscle dysfunction in Takotsubo cardiomyopathy
• Echocardiogram
• Ultrasound examination which allows doctors to look for the typical pattern of heart muscle dysfunction in Takotsubo cardiomyopathy
• Cardiovascular magnetic resonance imaging ('Cardiac MRI')
• Specialised scan looking specifically at the heart muscles abnormalities in Takotsubo cardiomyopathy
  

Takotsubo cardiomyopathy is a transient condition for most of the patients. The heart weakening often recover given time and many patients recover their heart functions completely. While waiting for heart recovery, patients are often put on medications which can potentially improve their heart functions.

Patients with Takotsubo cardiomyopathy often need repeat cardiac imaging studies to look for signs of heart recovery.

The Cardiomyopathy Clinic at the National University Heart Centre, Singapore (NUHCS) provides a comprehensive evaluation and treatment service for patients with Takotsubo cardiomyopathy.

Panel A: Echocardiogram of a normal left ventricle (LV) during contraction phase

Panel B: Echocardiogram of a Takotsubo cardiomyopathy patient's heart during contraction phase, with weakness/ bulging of the apex of the heart (white arrows), giving it the characteristic 'Takotsubo' (Japanese octopus pot) appearance

Left ventricular angiogram during left ventricular contraction, showing the characteristic 'Takotsubo' (Japanese octopus pot) appearance of the left ventricle.