Review Article
Volume 8 Issue 6 - 2021
Broken-Heart Syndrome (BHS)—Real or Imagined? Also Known as Takotsubo Syndrome (TS), Tako-Tsubo-Like Left Ventricular Dysfunction, and Takotsubo Cardiomyopathy (TCM). Investigation and Review; the Diagnosis and Treatment of Its Varied Manifestations
Nicholas A Kerna1,2*, Hilary M Holets3,4, Abdullah Hafid5, Kevin D Pruitt6, ND Victor Carsrud7, Uzoamaka Nwokorie8, Silile Ndhlovu9, Joseph Anderson II10 and Sahalia Rashid11
1SMC–Medical Research, Thailand
2First InterHealth Group, Thailand
3Beverly Hills Wellness Surgical Institute, USA
4Orange Partners Surgicenter, USA
5Academy of Integrative Health and Medicine (AIHM), USA
6Kemet Medical Consultants, USA
7Lakeline Wellness Center, USA
8University of Washington, USA
9MyPainDoc PC, USA
10International Institute of Original Medicine, USA
11All Saints University School of Medicine, Dominica
*Corresponding Author: Nicholas A Kerna, (mailing address) POB47 Phatphong, Suriwongse Road, Bangkok, Thailand 10500.
Received: April 27, 2021; Published: May 31, 2021


Takotsubo syndrome (TS) can be fatal due to its associated complications. Moreover, at this time, studies on the long-term prognosis after surviving the initial TS episode are inconclusive. There seem to be no differences based on age or gender. A significantly lower survival at 3 years was noted compared to the general population.

It has been reported that 1–2% of Asian and Western (mainly Caucasians) populations with suspected acute coronary syndrome (ACS) receive a final diagnosis of TS. In the US, about 6,837 patients were diagnosed with TS in 2008, increasing to 17,864 in 2009. Currently, considering the US and the UK data, 50,000–100,000 patients may be affected annually by TS.

The commonly reported risk factors for TS are tobacco smoking, alcohol consumption, anxiety disorder, and dyslipidemia. Elderly patients are at a high risk for TS and related complications. More than 90% of patients with TS are older than 50 years (65 years by some estimates) with hypertension and other cardiovascular diseases as comorbidities. The TS mortality rate is significantly higher among men than women..

In the 1990s, researchers Sato and Dote characterized takotsubo syndrome as an acute neurogenic-stunned myocardium. Since ACS has similar clinical and electrocardiographic presentations as TS, it is crucial to note that the characteristic finding of TS includes regional left ventricular wall-motion abnormality associated with an atypical circumference to systolic left ventricular ballooning.

Also, nearly one-third of patients with TS may present with a right ventricular abnormality. In most cases, the acute attack of TS is preceded by emotional stressors, such as grief or the death of a loved one. Triggers of TS in specific patients include intracranial hemorrhage, sepsis, pregnancy, and intercourse.

Also, nearly one-third of patients with TS may present with a right ventricular abnormality. In most cases, the acute attack of TS is preceded by emotional stressors, such as grief or the death of a dear one. Triggers of TS in specific patients include intracranial hemorrhage, sepsis, pregnancy, and intercourse.

TS demonstrates specific clinical findings in primary TS and secondary TS. In primary TS, the initial symptoms are cardiac conditions. In secondary TS, the cardiac conditions manifest in patients already hospitalized for other medical or surgical reasons. Secondary TS typically occurs in elderly, postmenopausal women hospitalized for other medical or surgical indications.

TS comprises a complex pathophysiology due to the body’s response to a sudden increase in endogenous catecholamine levels. Genetic predisposition for TS focuses on the α1‐, β1‐, and β2‐adrenergic receptors, GRK5, and estrogen receptor genes. Cardiac biomarkers, ECG, coronary angiography, ECHO, MRI, and radionuclide imaging are standard investigative tools in TS..

Although TS can resolve spontaneously, complications include acute heart failure, left ventricular outflow tract obstruction, mitral regurgitation, cardiogenic shock, arrhythmias, thrombi, pericardial effusion, ventricular wall rupture, and right ventricular involvement.

TS or broken heart syndrome is genuine, not simply a psychosomatic phenomenon that will wane with time or solely psychotherapy— having a specific pathophysiology and clinical features, which need to be addressed medically

Keywords: Asystole; Cardiomyopathy; Chest Pain; Depression; Grieving; Pericardial Effusion; Thrombus


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Citation: Kerna NA, Holets HM, Hafid A, Pruitt KD, Carsrud NDV, Nwokorie U, Ndhlovu S, Anderson II J, Rashid S. “Broken-Heart Syndrome (BHS)—Real or Imagined? Also Known as Takotsubo Syndrome (TS), Tako-Tsubo-Like Left Ventricular Dysfunction, and Takotsubo Cardiomyopathy (TCM). Investigation and Review; the Diagnosis and Treatment of Its Varied Manifestations”. EC Cardiology 8.6 (2021): 60-74.

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