Diagnosing Takotsubo Syndrome

Our cardiologists at NYU Langone Heart are experts at diagnosing takotsubo syndrome, also known as broken heart syndrome or stress cardiomyopathy. We use the most advanced diagnostic tests to assess your symptoms, confirm the correct diagnosis, and determine your underlying risk factors so we can lower your likelihood of having future heart problems.

Causes of Takotsubo Syndrome

The exact cause of takotsubo syndrome is unclear. The condition may be caused by imbalance in the autonomic nervous system, the part of the nervous system that controls the internal organs. The autonomic nervous system is made up of two nervous systems—the sympathetic (fight-or-flight response) and parasympathetic (rest-and-digest response). When these two systems are out of balance, a surge in stress hormones can disrupt normal heart muscle function.

Risk Factors for Takotsubo Syndrome

Although takotsubo syndrome can occur without any specific risk factors, there are certain factors that are commonly associated with an increased risk of developing the condition.

Age and Sex

While takotsubo syndrome can occur at any age, most cases are in people over the age of 50, and about 90 percent of cases are in women between the ages of 58 and 75. This may be due to changes in hormones experienced by women when they are postmenopausal.

Physical Stress

Serious physical illness or surgery can increase the risk of developing the syndrome. This can include conditions like sepsis, stroke, seizure, major bleeding, difficulty breathing, or significant trauma. Extreme exercise may also be associated with takotsubo syndrome.

Emotional Stress

People who have experienced major emotional stress, such as the death of a loved one, divorce, extreme anger, severe anxiety, or even extreme happiness, are at higher risk.

Certain Medical Conditions

People with a history of certain neurologic conditions, such as epilepsy or head injury, and certain psychiatric conditions, such as anxiety or depression, may have a higher risk of takotsubo syndrome. Research at NYU Langone has shown that some patients with takotsubo syndrome also have hypertrophic cardiomyopathy, an inherited muscle disease.

Symptoms of Takotsubo Syndrome

Symptoms of takotsubo syndrome usually mimic those of a typical heart attack. They may include discomfort in the chest, neck, jawline, upper stomach, or either arm; shortness of breath; nausea; vomiting; extreme fatigue; or a general sense of unease.

It is impossible for someone with heart attack symptoms to know whether they are having a heart attack or takotsubo syndrome. That is why it is important to go to an emergency department or call 911 right away if you experience symptoms like chest pain or shortness of breath, even if you think the cause is a stress in your life.

Takotsubo Syndrome Diagnostic Tests

NYU Langone cardiologists use a combination of blood tests and advanced imaging tests to precisely diagnose whether or not you have takotsubo syndrome. Our doctors are experts at detecting the subtle differences on these tests, which indicate whether someone has takotsubo syndrome or has experienced a typical heart attack, spontaneous coronary artery dissection, or another form of heart attack that affects women more commonly than men, such as heart attack with no blockage (MINOCA). 

NYU Langone cardiologists have led research showing that some patients with takotsubo syndrome have a form of hypertrophic cardiomyopathy, in which thickening of the heart walls causes a buildup of pressure that overloads the heart, interfering with its function.

Electrocardiograms

An electrocardiogram (ECG) records the electrical signals in your heart. In someone who has takotsubo syndrome, the test can reveal irregularities that mimic those of a heart attack, but with subtle differences that trained cardiologists at NYU Langone can identify.

Echocardiograms

This test uses ultrasound waves to produce detailed images of the heart’s structure and function. Takotsubo syndrome gets its name because it often causes the heart to lose its typical shape and instead resemble a Japanese pot for catching octopuses, called a takotsubo. An echocardiogram can review the unusual “ballooning” pattern of the left ventricle commonly observed in takotsubo syndrome.

Blood Tests

Use of blood tests can detect elevated levels of cardiac enzymes and proteins that typically leak into the blood during heart damage.

Coronary Angiogram

A coronary angiogram may be used to identify or rule out coronary artery blockages. This test involves injecting dye into the arteries via a long, thin tube, which allows X-ray imaging to capture detailed images of the heart’s arteries.

Cardiac Magnetic Resonance Imaging

Cardiac magnetic resonance imaging (MRI) uses a strong magnet to make highly detailed images of the heart, including its function and any areas of temporary or permanent damage. Cardiac MRI is helpful in patients who may have takotsubo syndrome to help distinguish it from heart attack, inflammation, or hypertrophic cardiomyopathy.