It looks like a cardiac infarction, but it's not. Tako-Tsubo syndrome, or stress-induced cardiomyopathy, is a rare disease that used to be confused with the far more common (and dangerous) cardiac infarction. Patients arrive at the emergency room with the characteristic heart attack symptoms: acute pain in the chest, a telltale electrocardiogram and the release of enzymes associated with typical heart disease. Yet when a coronarography is performed to locate the occlusion preventing blood from reaching the heart, nothing is found. This condition has been labeled "broken heart disease” because it affects mostly post-menopausal women, no longer protected by estrogen, and in 80 percent of cases, is associated with severe emotional stress, like a bereavement. Researchers in the Department of Cardiovascular Medicine of the Catholic University–Policlinico Gemelli of Rome, led by Filippo Crea, have identified the underlying mechanism of this unusual condition, and their work was published in a recent article in the European Heart Journal of the European Society of Cardiology. "In 80 percent of patients, symptoms disappear spontaneously after a couple of weeks, leaving no trace behind," explains Crea, "while in the other cases the damage persists. The fact is that the damage caused by this syndrome is in the heart but not in the coronaries. What we have tried to explain is the mechanism that leads to the onset of these symptoms." The group studied 15 women with an average age of 68. "We concentrated on the apical region of the heart," explains first author Leda Galiuto, "because that is the area where the dysfunction is localized.” The heart takes on the characteristic shape of an air balloon or, as the Japanese observed, of a local octopus trap, which is Tako-Tsubo in Japanese. The researchers developed the hypothesis that the dysfunction is due to spasms in the small coronary vessels, the so-called coronary microcirculation. "Microcirculation plays an important role in cardiac diseases", adds Crea, "and the intense vasoconstriction of these small vessels cannot normally be noticed in a coronarography." The researchers pioneered a diagnostic imaging procedure called myocardial contrast echography to study coronary microcirculation in a selective, safe and inexpensive way at the patient's bedside. They were able to demonstrate that this microvascular spasm is reversible and, once the acute phase is over, the dysfunction causing the symptoms is also resolved. "Usually patients are not left with any damage. Although the event is enough to keep the heart from contracting properly, which explains its balloon shape, it isn’t severe enough to cause the death of blood cells, which is what normally happens in an infarction,” concluded Crea.
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