Takotsubo (Stress) Cardiomyopathy (Broken Heart Syndrome) Clinical Presentation

Updated: Jul 31, 2019
  • Author: Eric B Tomich, DO; Chief Editor: Erik D Schraga, MD  more...
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The clinical presentation of patients ultimately diagnosed with takotsubo (stress) cardiomyopathy (broken heart syndrome) is usually indistinguishable from that of patients with acute coronary syndrome (ACS). The most common presenting symptoms of takotsubo cardiomyopathy are chest pain and dyspnea, although palpitations, nausea, vomiting, syncope and, rarely, cardiogenic shock have been reported.

One of the more unique features of takotsubo cardiomyopathy is its association with a preceding emotionally or physically stressful trigger event, occurring in approximately two thirds of patients. Unlike ACS, for which the peak occurrence is during the morning hours, takotsubo cardiomyopathy events are most prevalent in the afternoon, when stressful triggers are more likely to take place. [31]

A large systematic review found that patients with takotsubo cardiomyopathy tend to have a lower incidence of traditional cardiac risk factors, such as hypertension, hyperlipidemia, diabetes, smoking, or positive family history for cardiovascular disease. [26]


Physical Examination

Physical examination findings in patients with takotsubo (stress) cardiomyopathy (broken heart syndrome) are nonspecific and often normal, but the patient may exhibit the clinical appearance of acute coronary syndrome or acute congestive heart failure. Patients may appear anxious and diaphoretic. Tachydysrhythmias and bradydysrhythmias have been reported, but the average heart rate in one review was 102 bpm. [7]

Hypotension can occur from a reduction in stroke volume because of acute left ventricular systolic dysfunction or outflow tract obstruction. Murmurs and rales may be present on auscultation in the setting of acute pulmonary edema.