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Sripathi Sonika Shruti

Pursuing Doctor of Pharmacy

Stressors : An octopus trap

20 September 2020

Takotsubo cardiomyopathy (TTC) is an emerging cardiovascular disease , which is far from being completely known. It is generally referred to as apical ballooning or broken heart syndrome. It is usually triggered by a sudden emotional or physical stressor that leads to increased levels of catecholamine resulting in weakening of the left ventricle (the heart’s main pumping chamber).

Stressors associated with Takotsubo Cardiomyopathy :

  • Unexpected loss of loved ones

  • Sudden drop of blood pressure

  • Domestic violence

  • Asthma attack

  • Car or other accident

  • Intense fear

  • Fierce argument

  • Sepsis, shock

  • Winning a jackpot

  • Intense exercise

  • Wedding

  • Surprise birthday

  • Financial loss

Catecholamines such as adrenaline and norepinephrine from extreme stress or tumor secreting these chemicals play a central role. Excess catecholamines when released directly by nerves that stimulate cardiac muscle function. This adrenaline surge triggers the arteries to tighten, thereby raising blood pressure and placing more stress on heart that may spam the coronary arteries. This impairs the arteries from delivery adequate blood flow and oxygen to heart muscle. All together they can lead to congestive heart failure and decrease the heart’s output of blood with each squeeze. Takotsubo cardiomyopathy mimics acute coronary syndrome and is accompanied by reversible left ventricular apical ballooning. The name takotsubo is a Japanese word which means “octopus trap” , because the left ventricle of the heart takes on a shape resembling an octopus trap when affected by this condition. Reviews show that many people experience a major stressor out of which 41-50% was due to physical stressor and 26-30% was due to emotional stressor.

At older age postmenopausal women are more likely to get affected by this and at younger patients, males are often affected. TTC occurs worldwide and is responsible for 2% of all acute coronary syndrome cases presenting to hospitals. TTC’s main symptom is usually sudden sharp chest pain (most common), shortness of breath, fainting, but some cases can be complicated by cardiogenic shock, heart failures, dangerous ventricular arrhythmias or even cardiac rupture and death. Most of the abnormalities in systolic function and ventricle wall movement clear up in one to four weeks and most patients fully recover within two months. Although individuals with TTC show similar symptoms to a heart attack but there is no evidence of blocked coronary arteries and recover quickly. Most patients that develop TTC fully recover within one month and recurrence is rare. Diagnosis of TTC was established by the presence of typical apical ballooning pattern of the left ventricle shown by ventriculography or echocardiography and by the absence of a significant coronary artery stenosis as demonstrated by coronary angiography.

There is no standard treatment for broken-heart syndrome. It depends on the severity of symptoms, and whether the person has low blood pressure or evidence of fluid backing up into the lungs. Clinicians often recommend standard heart failure medications such as beta blockers, ACE inhibitors, and diuretics. They may give aspirin to patients who also have atherosclerosis. Although there's little evidence on long-term therapy, beta blocker may be continued indefinitely to help prevent recurrence by reducing the effects of adrenaline and other stress hormones. Death is rare.
In life there are numerous diseases or disorders affecting us even without our knowledge about their existence. Takotsubo Cardiomyopathy is one of such disease which is partially under lime light. Controlling emotions is what one has to learn for both having a peaceful living and not to get affected by this TTC disease. There’s nothing to worry about this disease if you are aware of it because it’s often misguided as heart attacks but it’s actually not.

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