Japanese Octopus Trap

Tako-Tsubo Syndrome
Tako-Tsubo Cardiomyopathy

also known as
Stress Cardiomyopathy
(Catecholaminergic) Myocardial Stunning
(neurogenic) Myocardial Stunning

Broken Heart Syndrome

All Images on this site © Striped Giraffe Press, December 2005. All rights reserved.  


Tako-Tsubo syndrome is a dreadful illness (albeit quite rare) that appears under circumstances of exceptional and extreme stress, at times associated with anger. If this is happening to you, you should try to calm yourself down, if at all possible (although most patients recover completely if supported adequately in a hospital !!!).

Please read one column after the other.

Some comments on Tako-Tsubo Syndrome

About 80% of cases of Tako-Tsubo Syndrome (TTS) occur in post-menopausal women under some form of extreme, exceptional and prolonged mental stress,... with no good way out, no relief and often feeling deep resentment (such as the loss of a dear one...)

(Note: a word of caution... , in a minority of patients (<20%) the stress is physical (such as massive trauma, surgery or severe pain, or other type of stress. In very rare cases, no "cause" can be found).

Tako-tsubo Cardiomyopathy or Syndrome is also known as:

  • neurogenic myocardial stunning,
  • stress cardiomyopathy
  • stress-induced cardiomyopathy,
  • transient left ventricular apical ballooning,
  • "ampulla" cardiomyopathy
  • "broken heart syndrome".

"Tako-tsubo" is the japanese name for octopus traps that fishermen still use to catch octopus. In this syndrome, the heart (left ventricle) takes the shape of an octopus trap (tako-tsubo). How about that!

NOTE ( très mucho IMPORTANT and before we forget ! A diagnosis of Tako-Tsubo syndrome can only be made after excluding:

  • coronary artery disease (especially proximal left main or left anterior coronary artery stenosis),
  • acute coronary syndrome,
  • acute myocardial infarction,
  • myocarditis, pericarditis, aortic dissections and so forth...

The shape that the left ventricle takes (Tako-Tsubo shape) is due to a state of complete exhaustion of the heart muscle (myocardial stunning) in the mid-section and tip of the heart. The fascinating part is that it occurs in patients without significant blockage (stenosis) of their coronary arteries (now: that is surprising and remarkable!).

A profound tako-tsubo syndrome is quite dangerous if not recognized as it can lead to transient but severe (occasionally lethal) cardiogenic shock. Electrocardiogram can show non-specific ST-T abnormalities, ST elevation, and/or QT prolongation with large negative T waves. Sometimes those changes occur in succession. And here is another surprise: the cardiac bio markers of heart damage (troponin, creatine kinase) are only very slightly elevated, confirming that there is not much heart muscle damage, but severe suffering (stunning) instead.

And that leads to the good news, Folks!
If this syndrome is recognized, over 95% of patients pull through that severe episode fairly easily (with most of the time complete recovery of the electrocardiographic changes and recovery of the cardiac shape and function. This may take a few weeks).

Suggestion: patients should be send to cardiac rehabilitation and if possible to a stress reduction clinic if the syndrome is complicated by continued stress or by a syndrome similar to PTSD (post-traumatic stress syndrome>.
The idea is to prevent recurrence (which is low but still exists) by indentifying and trying to eliminate or deflect stressors while educating patients how to counter and how to develop resilience to stress .

What about tako-tsubo syndrome in the animal kingdom? Despite fancy experimental research protocols designed by the meanest animal on the planet (namely: homo "the meanest mammal" sapiens), tako-tsubo syndrome has not been found in any type of animal as far as we know (except a rat model...
Ueyama T. Emotional stress-induced Tako-tsubo cardiomyopathy: animal model and molecular mechanismAnn N Y Acad Sci. 2004 Jun;1018:437-44


Rare video clip in a snowy mountain range of an unfortunate stressed, resentful and angry giraffe running after some scrumptious food. Conclusion from this study: Even maximally stressed giraffes don't get tako-tsubo syndrome......

But there is no need for those fancy experiments...... how about studying non-human primates stuck for life in zoos? I would not be surprised that some Tako-Tsubo cases could be found there....... future will tell... But we should not wait and free those poor primates in their appropriate habitat, with human primates protection.

poor crying monkey


Shape of the Left Ventricle in Tako-Tsubo Cardiomyopathy

Normal left ventricular contraction

Normal LV contraction

Abnormal contraction of left ventricle taking the shape of a "Tako-Tsubo"

Tato-tsubo LV contraction

Left ventriculogram in a patient with Takotsubo syndrome
Actual Left ventriculogram in a patient with tako-tsubo syndrome.

Post-menopausal woman - Cardiac ultrasound in the E.R. - Day 1 of a tako-tsubo syndrome: the left ventricular tip (apex) is "paralyzed"

Same patient, 3 months after the tako-tsubo episode: there is full recovery. The tip of the left ventricle contracts normally again. Yesss!

Syndrome named by Sato et al.
Sato H, Tateishi H, Uchida T, Dote K, Ishihara M. Tako-tsubo-like left ventricular dysfunction due to multivessel coronary spasm. in: Clinical Aspect of Myocardial Injury: From Ischemia to Heart Failure. Kodama K, Haze K, Hori M, Eds. Kagakuhyoronsha Publishing Co., Tokyo, 1990: 56–64 (in Japanese).

Syndrome seen in Worcester Massachusetts for a long time (followed up prospectively for up to 11 years) but named differently. "Massive T wave inversion mainly in women, with prognosis independent of ECG changes".
LA Walder and DH Spodick. Global T wave inversion: long-term follow-up. J Am Coll Cardiol, 1993; 21:1652-1656. Division of Cardiology, St. Vincent Hospital, Worcester, Massachusetts

Multivessel coronary artery spasm is a possibility.
Dote K, Sato H, Tateishi H, Uchida T, Ishihara M. Myocardial stunning due to simultaneous multivessel coronary spasms: a review of 5 cases. [Article in Japanese] J Cardiol. 1991;21(2):203-14.

Neurogenic cause is quite likely.
Akashi YJ, Nakazawa K, Sakakibara M, Miyake F, Musha H, Sasaka K.. 123I-MIBG Myocardial Scintigraphy in Patients with “Takotsubo” Cardiomyopathy. J Nucl Med 2004; 45:1121–1127

First patient cohort described in the U.S.
Seth PS, Aurigemma GP, Krasnow JM, Tighe DA, Untereker WJ, Meyer TE. A Syndrome of Transient Left Ventricular Apical Wall Motion Abnormality in the Absence of Coronary Disease: A Perspective from the United States. Cardiology, 2003;100:61-66

ALERT: what some of us expected to see described has just been ...described...
While most cases of tako-tsubo syndrome involve the tip of the heart, this can also happen in different area of the left ventricle: it is also transient and reversible. Masatoshi Shimizu , Yukio Kato , Hiroyuki Masai , Takashi Shima , Yoichi Miwa. [Recurrent episodes of takotsubo-like transient left ventricular ballooning occurring in different regions: a case report] (in japanese) J Cardiol. 2006 Aug ;48:101-7










Attention: instead of the characteristic takotsubo shape that the heart takes, some patients have, instead, focal or even completely diffuse wall motion abnormalities and therefore the "tako-tsubo" morphological change is not seen... Future research will sort out whether those cases should also be grouped into tako-tsubo syndrome.

Nevertheless, transient catecholaminergic myocardial stunning could still be the basis for some of those clinical presentations in patients with little or no coronary stenosis






















syndrome can appear because of an extremely, out of the ordinary, stressful episode, especially if it is associated with anger, resentment , and/or despair, mainly in women (men tend to drop dead or have a real heart attack because of stress... true! Hey! STRESS IS BAD FOR ANYBODY!). It is therefore key to try to calm yourself down (if necessary with outside help from friends and health practitioners) so that you don't let your octopus out of its tako-tsubo. Once the nervous system is so terribly activated you risk the following (especially women) with or without a full blown tako-tsubo syndrome:

Note that central nervous system with its sympathetic and parasympathetic systems is trying to continuously regulate many aspect of our lives. But it can be responsible for innumerable conditions. Such as:

  • myocardial stunning,
  • heart failure,
  • cardiogenic shock,
  • chest pressure-pains (similar to angina),
  • coronary spasm,
  • shortness of breath,
  • palpitations (arrhythmia, sometimes extremely serious)...

Treatment: Tako-tsubo syndrome is only treated with support measures.
Excellent revovery in 95% of cases but often with longstanding PTSD as a very important sequella. Recovery takes place over a few days with full recovery can take weeks in some patients. Recurrence is fortunately rare (10% of cases at most) and 0% if Tako-Tsubo Syndrome was primarily due to a medical ailment that was completely corrected (such as trauma or infection).

Unrecognized or untreated Tako-Tsubo Syndrome:
Untreated/Unrecognized Tako-Tsubo Syndrome can lead to:


Over reaction of medical stuff, with overtreatment of hypotension and shock with vasopressor agent that can lead to worsened condition and even death

Unrecognized Tako-Tsubo Sybdrome can also lead to the lack of understanding of underlying stress: patients can then with other stress related ailments such as PTSD, depression, stress induced gastritis and ulcers that can lead to massive gastrointestinal bleeding,... and so forth.


Note that to this date (when you will read this webpage) Tako-Tsubo Syndrome is often missed because:

  • (1) it is mild, transient and recovers quickly,

  • (2) but most often it is because patients are admitted with a severe conditions such ailments names in the list below, and physicians and nurses miss Tako-Tsubo Syndrome that appears 24 hours later.
  Any type of Severe Intracranial condition
Severe Pneumonia
Severe Asthma
Severe COPD
Decompensated Diabetes
Severe Hyper or HypoTension
Severe Trauma
Severe hemorrhage
Severe Allergic reaction
Severe Sepsis of any cause
Severe Inflammation of any cause
Severe Burns

Root cause of tako-tsubo syndrome: Mental/Physical Stress appears to be the underlying root cause in many cases. Because of this, some have investigated an excessive endogenous norepinephrine release over the heart muscle. This mechanism is now generally accepted by the medical community. Regarding treatment: as stated above, we really only have standard support measures that we give to other patients with standard heart failure and stress. There are some attempts to give a calcium channel blocker to prevent coronary spasm, but there is no solid literature on that. Besides, patients often have low blood pressure, preventing us from giving a vasodilator such as a calcium channel blocker. Some physicians prescribe betablockers as tolerated (for instance: low dosage initially). But this is not accepted by everyone.

Like everything else: better prevent and recognize Tako-Tsubo Syndrome as early as possible rather than wait for the full syndrome.









Take a deep breath and relax (but don't breath to fast ,... or you will become dizzy and panicky...) breathing