Photo: Orlando Durán Hernández / Adelante CAMAGÜEY.- Takotsubo cardiomyopathy consists of a change in the geometry of the left ventricle * of the heart that normally has an ellipsoid shape and when this organ is subjected to unusual stress, it can change that shape towards an ovoid and the segments of the middle towards the tip of the heart stop moving and only the segments of the base do.

This was explained by Dr. Rafael León de la Torre, 1st. and 2nd. Degree specialist in Cardiology, Master in Critical and Emergency Patient Care and Assistant Professor of that service of the university hospital Manuel Ascunce Domenech, of this city, who graciously agreed to our request.

"The form adopted is that of a takotsubo, which is a vessel used to capture octopuses at sea in Japan, a country where the Syndrome was described. Perhaps if we had glimpsed it in Camagüey we would have called it the Tinajón Syndrome, because in reality the description of that vessel and the similarity with the Camagüey’s tinajón is very similar. "

— What sex does it predominate in?

—In post-menopausal women undergoing some type of stress that can be psychic, surgical, acute or sudden causes, although it also appears in younger persons and in those early ages when the heart suffers this variation in motility, it arises a curiosity and it is called an inverse Takotsuba, because the part that stops moving is the base and the tip continues its movement, but the classic one was the one I exposed at the beginning, with a lack of contractility in the middle apical segments and is only activated base.

— Can it be confused with another heart condition?

—Yes, you may think of a heart attack at the beginning.

—What are the symptoms?

—Patients report chest pain or with manifestations of heart failure, that is, they lack air, and the electrocardiogram is almost always abnormal and often indistinguishable from a heart attack and hence the confusion of which I spoke.

—And if it gets confused, what are the consequences?

—In the beginning the treatment is the same, it is a sudden illness, so you have to try, like everything in medicine, to relieve the fundamental symptom, if it is chest pain you have to relieve it, if it is heart failure, then attenuate it.

— How would it be diagnosed then?

—Many times it is a diagnosis of exclusion, because when we assist the patient we always go to the most frequent thing that in these cases it is a heart attack, but then we assess the case again and take into account the interrogation is very useful at the time of the suspicion, because the history of marked stress must be considered and must be sought, otherwise we do not find it.

“I have faced some cases and when I ask, it is answered with the loss of a loved one, but it is a differential diagnosis. In current medicine, acronyms that are MINOCAs are used, which would be in Spanish: Cardiac Infarction with Non-Occluded Coronary Arteries. This means that you have the patient with suspected infarction, you stabilize it, you manage to perform a coronography (contrasted study that is performed in an invasive way to look for obstruction in the coronary circulation) and if that supposed infarction throws a normal coronography one is a little surprised , then we think of a MINOCA and this leads us to several diagnostic possibilities, and among these the Takotsubo Syndrome ”.

— Is it something frequent?

— It's not usual, but maybe it's because it escapes us. The diagnosis with images is the most accurate to observe the deformity of the left ventricle, by means of an echocardiogram, nuclear magnetic resonance, or a ventriculography that is done during the study of a coronography.

—If it is suspected in Camagüey, how far would the study go?

—We have the echocardiogram and it is very helpful because the management of this equipment would be different to try to recover that heart that stopped moving as I referred before and help it recover with a specific treatment, and I insist, it is a diagnosis of exclusion. Our teachers taught us to diagnose, and how these entities happen, if the frequent does not classify, then go to the oddities, although it is not so rare, we are under stress every day.

—We think it's already detected, is it cured?

— Often yes. That ventricle can return to normal; nevertheless, in the acute phase, in a heart that has stopped moving from its middle part towards the tip, it is not ruled out that it leads the person to acute heart failure, to the state of shock, or to hypo-tension and death. In the acute phase it is serious.

"After the acute phase and treated correctly, it is not ruled out that the heart will recover its morphology and motility."

— Does it repeat?

— I have attended people with recurrent symptoms due to stress also on the second occasion and the good to receive, a lady suffered it in the tribute of a group that appreciated and she got excited.

“The most important thing is to diagnose it early; however, if a person is hypertensive, diabetic, smokes and has cardiac relatives, and comes to our hands with a symptom like the one mentioned, the first thing to think about is an acute ischemic heart disease, although there are infarcts without this background, although they are less.

"The possibility of diagnosing it in a timely manner is through the echocardiogram, of course, if it shows the aforementioned history."

— Is this syndrome known by another name?

— Broken heart syndrome.

— Why if it is not broken?

— Rather it is a metaphor, something even poetic, it is as if it literally broke the heart.

* Left ventricle is one of the four cavities of the heart (two atria and two ventricles). It is the portion of the heart with the greatest amount of muscle tissue because the left ventricle is the one that drives blood to the aortic artery, which carries blood to most of the body.

Translated by Linet Acuña Quilez