The Southern Medical Journal (SMJ) is the official, peer-reviewed journal of the Southern Medical Association. It has a multidisciplinary and inter-professional focus that covers a broad range of topics relevant to physicians and other healthcare specialists.

SMJ // Article

Editorial

The "Tako-tsubo" Phenomenon and Myocardial Infarction

Authors: Kim Connelly, MBBS, FRACP, Andrew MacIsaac, MD, FRACP, FCSANZ, Michael V. Jelinek, MD, FRACP, FCSANZ

Abstract

Over the past 10 years there has been increasing evidence that acute emotional stress can induce myocardial infarction (MI) in individuals without overt coronary artery disease.1,2 The lay population has recognized this phenomenon for centuries, and phrases like “scared to death” and “died as a result of a broken heart” have made their way into everyday language. In contrast, the medical community has been skeptical of this association. Initially described in Japan,3 “tako-tsubo” cardiomyopathy was used to describe a syndrome which predominantly affected middle-aged women, was brought on by acute emotional stress, was characterized by mild creatinine kinase and troponin I elevations, and by the left ventriculogram demonstrating hypo- or akinesis from the mid portion of the anterior wall to the apex and hyperkinesis of the basal area. Importantly, all wall motion abnormalities resolved usually within 30 days. The term “tako tsubo” was used as the appearance of the left ventriculogram looked like a tako tsubo, an instrument used to trap octopi in Japan (tako = octopus, tsubo = pot).

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Wittstein IS, Thiemann DR, Lima JA, et al. Neurohumoral features of myocardial stunning due to sudden emotional stress. N Engl J Med 2005;352:539–548.
 
2. Dec GW. Recognition of the apical ballooning syndrome in the United States. Circulation2005;111:388–390.
 
3. Dote K, Sato H, Tateishi H, et al. Myocardial stunning due to simultaneous multivessel coronary spasms: a review of 5 cases. J Cardiol 1991;21:203–214.
 
4. Connelly KA, MacIsaac AI, Jelinek VM. Stress, myocardial infarction, and the “tako-tsubo” phenomenon. Heart. Sep 2004;90:e52.
 
5. Desmet WJ, Adriaenssens BF, Dens JA. Apical ballooning of the left ventricle: first series in white patients. Heart 2003;89:1027–1031.
 
6. Tibrewala AV, Moss B, Copper HA. A rare case of tako-tsubo cardiomyopathy complicated by a left ventricular thrombus. South Med J 2006;99:70–73.
 
7. Ibanez B, Navarro F, Cordoba M, P, et al. Tako-tsubo transient left ventricular apical ballooning: is intravascular ultrasound the key to resolve the enigma? Heart 2005;91:102–104.
 
8. Sharkey SW, Lesser JR, Zenovich AG, et al. Acute and reversible cardiomyopathy provoked by stress in women from the United States. Circulation 2005;111:472–479.
 
9. Kurisu S, Sato H, Kawagoe T, et al. Tako-tsubo-like left ventricular dysfunction with ST-segment elevation: a novel cardiac syndrome mimicking acute myocardial infarction. Am Heart J. 2002;143:448–455.
 
10. Bybee KA, Prasad A, Barsness GW, et al. Clinical characteristics and thrombolysis in myocardial infarction frame counts in women with transient left ventricular apical ballooning syndrome. Am J Cardiol2004;94:343–346.
 
11. Mayer SA, Lin J, Homma S, et al. Myocardial injury and left ventricular performance after subarachnoid hemorrhage. Stroke 1999;30:780–786.
 
12. Bunker SJ, Colquhoun DM, Esler MD, et al. “Stress” and coronary heart disease: psychosocial risk factors. Med J Aust 2003;178:272–276.
 
13. Rosengren A, Hawken S, Ounpuu S, et al. Association of psychosocial risk factors with risk of acute myocardial infarction in 11119 cases and 13648 controls from 52 countries (the INTERHEART study): case-control study. Lancet 2004;364:953–962.
 
14. Kop WJ, Krantz DS, Howell RH, et al. Effects of mental stress on coronary epicardial vasomotion and flow velocity in coronary artery disease: relationship with hemodynamic stress responses. J Am Coll Cardiol 2001;37:1359–1366.
 
15. von Kanel R, Mills PJ, Fainman C, et al. Effects of psychological stress and psychiatric disorders on blood coagulation and fibrinolysis: a biobehavioral pathway to coronary artery disease? Psychosom Med 2001;63:531–544.
 
16. Lewthwaite J, Owen N, Coates A, et al. Circulating human heat shock protein 60 in the plasma of British civil servants: relationship to physiological and psychosocial stress. Circulation 2002;106:196–201.