Rare acute cardiac disease, its incidence increased during the pandemic. Among the causes, the action of the virus, but also stress
What do an octopus and an EKG have in common? Nothing, at least until 1990, when a strange pathology was described for the first time in Japan, whose name seems to be that of a manga hero: Takotsubo. Thus the cephalopod mollusc – which someone once called “the dancer of the sea” – ends up straight in medical books. Reason? The shape of the patients heart, which brings to mind the basket (tsubo) of the traditional octopus fishing (so).
It is a rare acute cardiac syndrome characterized by chest pain, changes in the electrocardiogram, increased cardiac enzymes. Simulate myocardial infarction, but there is a big difference: during coronary angiography, an invasive procedure that allows you to view the arteries that distribute blood to the heart, the atheroslcerotic plaques that occlude the lumen of the vessel are not found. Segmental ventricular dysfunction occurs, which gives the typical transient “balloon” swelling of the apex of the left ventricle and its middle portion, found during ultrasound or cardiac magnetic resonance.
Patients should be hospitalized to monitor for complications, such as ventricular arrhythmias, heart failure, or changes in heart mechanics. Although rare, rupture of the left ventricle can occur, leading to sudden death. But with adequate therapies in the acute phase, the prognosis is favorable and complete recovery is possible in about two months, with a risk of relapse in 5% of cases. Although the exact causes are not known today, the syndrome usually affects women between the ages of 55 and 75, with an incidence in the general population of about 1 in 36,000. It is also called “stress cardiomyopathy” or “heartbreak syndrome” because triggers include intense emotions such as fear, anger, pain and anxiety.
According to a study conducted in the Cleveland Clinic (US medical center located in the homonymous city of Ohio) and published in the scientific journal Current Problems in Cardiology, during the pandemic, the incidence of Takotsubo syndrome increased significantly in people who contracted it Covid-19, both for cardiovascular complications directly or indirectly linked to Sars-CoV-2, and for widespread psychosocial distress. The correlation is not yet certain, but the hypothesized pathophysiological mechanisms are three: an overactive immune response due to the cytokine storm, an increased activity of the sympathetic nervous system and of catecholamines – the neurotransmitters adrenaline, noradrenaline and dopamine – and the development of microvascular dysfunction, that of the small arterial coronary vessels. Increase also found in the general population: the collapse of the economy, the difficulties related to distancing and the fear of contracting the virus have in fact exasperated the levels of anxiety, panic and depression. Another interesting aspect reported by the study is the link between the frequency of the disease and previous natural disasters, such as the 2004 earthquakes in Niigata, Japan, and the 2011 earthquakes in Christchurch, New Zealand.
Takotsubo syndrome which is also present in the world of cinema. In fact, it seems to have been the cause of the death of Debbie Reynolds, Hollywood star of the fifties and sixties, who died a few hours after her daughter Carrie Fisher, Princess Leia in the saga Star Wars.
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January 28, 2021 (change January 28, 2021 | 13:41)
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