I can recall my first case of the Broken Heart Syndrome (also known as Takotsubo Cardiomyopathy or Stress Cardiomyopathy) 30 years ago or more. The woman was having a classic presentation for a major heart attack but when I performed emergency cardiac angiography, her arteries were clean. Yet, her heart was damaged. How could that be. Japanese researchers had reported that extreme grief or stress, particularly in women, can mimic a classic heart attack due to advanced plaque, yet there was no plaque.
We are still learning about this syndrome and
new report is a reminder that Takotsubo cardiomyopathy continues to be a major cause of mortality and morbidity. The goal of this study was to evaluate the outcome data of patients with Takotsubo cardiomyopathy using a large inpatient database.
STUDY
Researchers from Tucson, Arizona used the Nationwide Inpatient Sample database for thestudy. They evaluated trends, mortality, and complications of patients admitted with Takotsubo cardiomyopathy from available years 2016 to 2020 in adults >18.
A total of 199 890 patients with Takotsubo were found in the database with 83% being female and higher prevalence with age, White race, and highest income.
Mortality was high at 6.5% with no significant improvement over the years studied.
Furthermore, major complications were substantial. Cardiogenic shock occurred in 6.6%, atrial fibrillation in 20.7%, cardiac arrest in 3.4%, congestive heart failure in 35.9%, and stroke in 5.3%.
Mortality was more than double in men in comparison to women (11.2% versus 5.5%).
CONCLUSIONS
Takotsubo cardiomyopathy is associated with high mortality and complications with no improvement in outcome over the 5‐year study with higher mortality in men.
Clinicians need to improve care of these patients to reduce mortality and study the reason for sex differences in outcome
Originally, it was thought that these episodes were "one and done" and the outlook was good. This report is a call for more research on the optimal strategies for prevention and treament as repeated episodes are now routinely seen.
The mainstay therapy was the use of a beta blocker for some period of time after the event. Now there are many "heart failure" medications. I urge my patients to consider counseling for stress management, breathing exercises, yoga, acupuncuture, sleep therapy, adaptogenic herbs, and other approaches.
