Talk:Takotsubo cardiomyopathy

Wiki Education Foundation-supported course assignment
This article is or was the subject of a Wiki Education Foundation-supported course assignment. Further details are available on the course page. Student editor(s): Srossini, Cwy96, Susan.thana, Repletev.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 10:40, 17 January 2022 (UTC)

Wiki Education Foundation-supported course assignment
This article was the subject of a Wiki Education Foundation-supported course assignment, between 8 January 2020 and 25 March 2020. Further details are available on the course page. Student editor(s): Mr. Bubs.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 10:40, 17 January 2022 (UTC)

Conflicting name explanation
Currently, the header includes the following texts:

It is the hallmark bulging out of the apex of the heart with preserved function of the base that earned the syndrome its name "tako tsubo", or octopus trap in Japan, where it was first described.[3] It is thus named because of the popular Japanese myth that an octopus farmer once fell in love with one of his octopi, and upon being spurned he died of a broken heart

These two explanations are mutually contradictory. Given that the first is referenced, I will flag the second with a citation needed tag. Ordinary Person (talk) 10:53, 8 August 2009 (UTC)

Trivia?
The section on how the disease inspired David X. Li to develop the Gaussian copula models seems like trivia. I want to remove it. Thoughts? Rytyho usa (talk) 06:03, 24 April 2013 (UTC)
 * I agree. Have removed content. Millionmice (talk) 03:18, 14 April 2014 (UTC)

Loose refs
Added to the "references" section:
 * Sharkey, S., Lesser, J., & Maron, B. (2011). Takotsubo (stress) cardiomyopathy. American Heart Association. Retrieved from http://circ.ahajournals.org/content/124/18/e460.full
 * Winslow, R. (2010). Hearts actually can break. The Wall Street Journal. Retrieved from http://online.wsj.com/articles/SB10001424052748703615904575053443911673752
 * Kane, J. (2012). Broken heart syndrome: Yes, it’s real. PBS. Retrieved from http://www.pbs.org/newshour/rundown/broken-heart-syndrome-yes-its-real/

For reference. JFW &#124; T@lk  23:04, 14 December 2014 (UTC)

Star Wars; Padme Amidala death
Shouldnt it be added in a "in popular media" section that Padme Amidala in Star Wars Episode 3 died because of a broken heart??? like a trivia info?The Ouroboros, the Undying, the Immortal (talk) 19:37, 27 May 2015 (UTC)
 * It's my feeling that cultural topics may have a "trivia section" added, but I don't see where scientific articles should have one. Thank you & Happy New Year, Wordreader (talk) 07:35, 22 December 2016 (UTC)

Are these conditions the same or not?
I read a very brief article here on WP called Parasympathetic rebound, which sounds a whole lot like this condition. How does Parasympathetic Rebound differ from this condition? If it does not, then the articles should be merged and perhaps PR requests sent here? If they do differ, then an internal link is in order. Thank you & Happy New Year Wordreader (talk) 07:32, 22 December 2016 (UTC)


 * Takotsubo is thought to be sympathetically mediated. JFW &#124; T@lk  10:08, 23 December 2016 (UTC)

Requested move 9 March 2017

 * The following is a closed discussion of a requested move. Please do not modify it. Subsequent comments should be made in a new section on the talk page. Editors desiring to contest the closing decision should consider a move review. No further edits should be made to this section. 

The result of the move request was: Not moved. Opposition consensus does not support this as the current title is suitable. --  Dane talk  00:58, 25 March 2017 (UTC)

Takotsubo cardiomyopathy → Takotsubo syndrome – The term 'cardiomyopathy' is misleading. Clear evidence of structural changes characteristic of cardiomyopathy is missing. Eleassar my talk 12:33, 9 March 2017 (UTC)


 * Stay - Takotsubo cardiomyoptahy seems to be the far more common name. PriceDL (talk) 12:46, 9 March 2017 (UTC)
 * Agree TC is what emedicine uses as does MESH  Doc James  (talk · contribs · email) 10:27, 20 March 2017 (UTC)


 * The above discussion is preserved as an archive of a requested move. Please do not modify it. Subsequent comments should be made in a new section on this talk page or in a move review. No further edits should be made to this section.

Pathophysiology
Circulation 10.1161/CIRCULATIONAHA.116.027121 JFW &#124; T@lk  22:27, 13 June 2017 (UTC)

Suggested Edits
Hello, we are a group of medical students editing this page as part of our class assignment. We have compiled a list of suggestions to improve this article and would appreciate community feedback before we proceed with these edits. Here is a list of our suggestions:

1. We noticed that reference #26 is a primary source. We could not find any WP:MEDRS sources that can be used as a replacement. Moreover, the source appears to be plagiarized. We propose to remove the source and the 4 sentences that use it as a citation from the Takotsubo Cardiomyopathy#Diagnosis section.
 * Before you remove this content, were you able to find any WP:MEDRS sources that could be used instead? JenOttawa (talk) 03:18, 15 November 2017 (UTC)
 * Thanks for the comment. In all recent review articles that I have read which discuss the diagnosis of Takotsubo Cardiomyopathy (for example:, ) histopathology is not mentioned as an important step in the diagnosis of TC, and it does not seem like this is routinely done in practice. That being said, I would be very open to hearing different perspectives from clinicians who actually diagnose TC in their practice! Srossini (talk) 14:56, 15 November 2017 (UTC)
 * Ok, I see that you just performed this edit. We will see what happens :). There are quite a few Wikipedians who follow articles, but are not necessairly following the talk pages closely. A good bold attempt at wiki editing, now time will tell if it will stick. Great work so far! JenOttawa (talk) 20:52, 22 November 2017 (UTC)
 * Thank you for your feedback! We didn't receive any objections on the Talk Page in the last week, so we figured we would go ahead and make the change and then see if we received any feedback later on. Our Wiki expert supported this change, too. Srossini (talk) 21:34, 22 November 2017 (UTC)

2. We propose to insert the following content in the Takotsubo Cardiomyopathy#Treatment section: “Although Takotsubo Cardiomyopathy is typically self-resolving, serious acute complications can arise which must be managed. These most commonly include congestive heart failure and cardiogenic shock, and less commonly include apical thrombosis, arrhythmias, and ventricular rupture.
 * can you re-word this a little so it is aimed more at a lay audience? e.g.: "TC usually goes away on its own"etc.JenOttawa (talk) 13:53, 5 November 2017 (UTC)
 * Thank you for your suggestion, here is my edit "Although the symptoms of Takotsubo cardiomyopathy usually go away on their own and the condition completely resolves itself within a few weeks, some serious complications can happen that must be treated. These most commonly include congestive heart failure and very low blood pressure, and less commonly include blood clotting in the apex of the left ventricle, irregular heart beat, and tearing of the heart wall. Srossini (talk) 14:49, 10 November 2017 (UTC)

3. We propose to remove the information in the “Cultural References” section completely because we do not believe that the information is relevant to the clinical course of Takotsubo Cardiomyopathy.
 * The article covers the disease comprehensively, including its cultural significance. It's not to be limited only to the clinical course. --Eleassar my talk 17:35, 18 November 2017 (UTC)
 * Thank you for your suggestions. We agree that the Cultural References section is relevant, and thus will be leaving it as is. Perhaps other content can be added to this section as well. Cwy96 (talk) 16:10, 22 November 2017 (UTC)

4. We propose to remove the first cause in the Takotsubo Cardiomyopathy#Causes section “1. Wraparound LAD…”. The source for this information is an outdated primary resource, with few participants. In this section we suggest to remove references #11 and #12 as they are original and outdated articles.


 * Did you do a literature search to see if any more recent RCTs have been reviewed anywhere?JenOttawa (talk) 19:14, 10 November 2017 (UTC)

Causes of Takotsubo cardiomyopathy have not been completely elucidated, however the ones listed in the article including transient vasospasm, microvascular dysfunction and apical stunning are supported in the literature.
 * Once again, try to use simple language (elucidated can be replaced with "not understood" or "unknown") JenOttawa (talk) 13:53, 5 November 2017 (UTC)


 * Thank you for your suggestions. We have reworded the content here, "Causes of Takotsubo cardiomyopathy are not completely understood, however the ones listed in the article including transient vasospasm, microvascular dysfunction and apical stunning are supported in the literature." Repletev (talk) 14:47, 10 November 2017 (UTC)
 * I was taking a closer look at the article, and also your suggested reference. What is wrong with the sentence that is presently in the article, with your citation added on: "The cause of takotsubo cardiomyopathy is not fully understood, but several mechanisms have been proposed including transient vasospasm, microvascular dysfunction and apical stunning. with the present subheadings underneath? Could you use your new source to improve one of the causes or replace one of the outdated references in the paragraphs?JenOttawa (talk) 19:14, 10 November 2017 (UTC)
 * Upon reflection the sentence does not need to change. The main alteration that is proposed is to delete cause "1. Warparound LAD...". The rest of the causes listed do have support in the literature as evidenced in the citation. The citation can be added to the end of the present sentence, "The cause of takotsubo cardiomyopathy is not fully understood, but several mechanisms have been proposed."Repletev (talk) 14:52, 15 November 2017 (UTC)
 * We propose to also add the cause catecholamine-induced myocyte injury as sub-heading on its own. Citation #19 is a good resource for this.

We propose to add the following sentence, " 4. Catecholamine-induced myocyte injury It has been suggested that the response to catecholamines (such as epinephrine and norepinephrine, released in response to stress) leads to injury that contributes to Takotsubo Cardiomyopathy. Repletev (talk) 15:13, 15 November 2017 (UTC)
 * You could specify what type of injury this is (muscle cell death or heart muscle injury)JenOttawa (talk) 01:51, 19 November 2017 (UTC)


 * Upon review, the mechanism by which a surge of catecholamine leads to takotsubo cardiomyopathy is not completely understood. It has been linked to myocellular hypoxia, membrane permeability changes as well as an increase in free radicals . Overall, these changes are related to heart muscle dysfunction.

As such I would like to write the following as an edit,
 * 4. Catecholamine-induced myocyte injury It has been suggested that the response to catecholamines (such as epinephrine and norepinephrine, released in response to stress) leads to heart muscle dysfunction that contributes to Takotsubo Cardiomyopathy. Repletev (talk) 22:42, 22 November 2017 (UTC)

5. We propose to remove the static echocardiogram image in the Takotsubo Cardiomyopathy#Diagnosis section as it is difficult to appreciate the dynamic changes in dilation of the left ventricle.
 * I suggest you wait for community feedback on this one. What did the cardiologist that you met with say about the image?JenOttawa (talk) 01:40, 19 November 2017 (UTC)
 * Thank you for your suggestion. We decided to propose this change based on our meeting with the cardiologist. They felt the image should be removed on the basis that it is difficult to appreciate the dynamic nature of the left ventricle with the static echocardiogram image. We will wait to see if there is any community feedback in regards to this proposed change.Swana.k (talk) 21:40, 22 November 2017 (UTC)

6. We propose to modify the sentence in the Takotsubo Cardiomyopathy#Prognosis section: “Although infrequent, recurrence of the syndrome has been reported and seems to be associated with the nature of the trigger” to “Although infrequent, annual recurrence of the syndrome has been reported at 1-2% and seems to be affected by the nature of the trigger, the severity of the cardiomyopathy, as well as the use of ACEi/ARB drugs.
 * Once again, I think you can "dub down" the language a little here. Seems a little too technical.JenOttawa (talk) 13:53, 5 November 2017 (UTC)


 * Thank you for your suggestions. We have reword the content here, “Annual recurrence of the syndrome has been reported at 1-2% and seems to be affected by the nature of the trigger, the severity, as well as the use of certain drugs. --Si.yuan.d (talk) 15:04, 10 November 2017 (UTC)
 * IMO "annual recurrence" is still not clear to me. Is there a way to re-word this? Is Takotsubo Syndrome recurs at a rate of 1-2% within the first year or per year what this means? This could just be me not interpreting it correctly.JenOttawa (talk) 01:48, 19 November 2017 (UTC)

7. We propose to update the reference for this sentence to a current secondary source:“It is likely that there are multiple factors at play that could include some amount of vasospasm, failure of the microvasculature, and an abnormal response to catecholamines (such as epinephrine and norepinephrine, released in response to stress)." new reference:
 * This new citation appears to be a recent review article, not open-sourced, but from a reputable journal. WP:MEDRS acceptable in my opinion. JenOttawa (talk) 13:53, 5 November 2017 (UTC)
 * There may have been some misunderstanding - we propose to change the current reference to the one listed here (and at the bottom of this section). The previous reference is a primary citation from 2005. --Blacklabcoats (talk) 14:08, 10 November 2017 (UTC)
 * Sorry, it was me that was not clear in my first comment. I looked at your proposed citation addition and I agree that it appears to be reliable as per WP:MEDRS. Thanks! JenOttawa (talk) 18:54, 10 November 2017 (UTC)

Additionally, the following statement requires a citation or it should be removed: “This heart dysfunction could be grouped within the psychosomatic disorders known as voodoo death”.
 * Could you find a WP:MEDRS citation for this? JenOttawa (talk) 03:18, 15 November 2017 (UTC)
 * I don't like that sentence either, even though it Wikilinks to the Voodoo death article. David notMD (talk) 18:54, 17 November 2017 (UTC)
 * Thanks for your contribution to the discussion Blacklabcoats (talk) 02:10, 19 November 2017 (UTC)
 * Are there any references to backup the voodoo death sentence?JenOttawa (talk) 01:40, 19 November 2017 (UTC)
 * Hi, although we can find resources that support 1) the statement that catecholamines are involved in TTS and 2) that catecholamines are thought to contribute to "Voodoo Death", I don't feel comfortable combining these two statements and concluding that therefore TTS should be lumped in with "Voodoo Death". If there are no objections from the community, then I will remove this sentence tomorrow. Blacklabcoats (talk) 02:10, 19 November 2017 (UTC)

8. The citation 36 in Takotsubo Cardiomyopathy#Treatment section regarding the use of ionotropic therapy as a possible treatment, we propose to be replaced with a current review regarding treatment of TTS, which indicates that ionotropic drugs should be used with caution.
 * Any changes to the text?JenOttawa (talk) 03:18, 15 November 2017 (UTC)

9. We propose to replace the reference #10, with a more current systematic review that discusses at the prevalence of emotional and physical stressors, hypertension, dyslipidemia and smoking TTS patients.
 * Any changes to the text? JenOttawa (talk) 03:18, 15 November 2017 (UTC)

</ref

10. We propose to modify the following sentence in the Takotsubo Cardiomyopathy#Diagnosis section: “Cardiac enzymes are usually negative and are moderate at worst, and cardiac catheterization usually shows absence of significant coronary artery disease” to “In most cases, cardiac enzymes such as creatine kinase, creatine kinase-MB, or troponin are moderately elevated and serve to support the initial diagnosis.
 * Can you try to add Wikilinks to some of these terms?JenOttawa (talk) 03:18, 15 November 2017 (UTC)

Repletev (talk) 15:16, 3 November 2017 (UTC) Group of Medical Students


 * COMMENT: Good work on formatting the citations. Good/Bold intent to delete text and refs and images, not just add. Ref 26 (? Dahr) appears to be a review, hence not primary. Can you paraphrase the sentences rather than delete? Also, in when in Talk, mention the first authors name rather than number, because someone else may be adding or removing references. When the total body of literature is not voluminous, don't be hasty to discard refs just because 10-15 years old. Sometimes that's all you got. If you remove refs that are used multiple times, make sure all use locations are deleted. David notMD (talk) 00:10, 4 November 2017 (UTC)
 * Thank you for your feedback. We will ensure that we paraphrase sentences instead of deleting them and be cautious when deleting unreliable references. Susan.thana (talk) 15:12, 10 November 2017 (UTC)
 * Where you are deleting old or inadequate citations, do the replacements require that the text be changed, too? If yes, suggest you try out your replacement sentences here in Talk. And a point I made to JenOttawa, who is assisting the class - often, articles have watchers that do not watch Talk, but rather only the article itself. So a dearth of feedback in Talk does not mean fireworks won't take place once the content is transferred to the article. This article gets about 36,000 visits a month, so there are a lot of eyes on it. David notMD (talk) 20:53, 10 November 2017 (UTC)

Cultural references
I have removed all "cultural references". The only cases that should be discussed need to be directly linked to diagnosed takotsubo, otherwise we'd have a list of everyone dying from "a broken heart". JFW &#124; T@lk  15:43, 16 June 2019 (UTC)

First hand observations.
This syndrome can be presented in the following real life case.

"A person sneaked up behind me, and turned me around, shoving his fist into my chest. I thought it was a knife, and in the blurr of the moment sought to remove it, only to find infraction tickets, part of a plot to extort some land.

The assalent drove off, leaving me to walk into my office. A minute later a severe stress came over my chest, and I lost most all power. I did not know what it was. In hindsite, the adrenal rush had somewhat frozen my heart, causing me to lose power.

The accute symptoms disappeared however, I progressed to get sick, over several months. A doctor, not knowing of this incident did an EKG of me, and suggested that I had suffered a heart attack. I did not recall a heart attack nor at the time, connect the two incidents.

This particular syndrome does show up on an EKG as a heart attack however that is not correct.

Hope this might help others.


 * Sorry to hear about your experiences!
 * Without commenting on your case specifically, one may wish to consider that persistent ECG changes cannot distinguish between a completed MI and Takotsubo. Cardiological evaluation would still be required. JFW &#124; T@lk  10:59, 7 July 2019 (UTC)

Etymology
thinks that the etymology should be discussed in a separate section, where I believe that the explanation is brief enough to include in the introduction. According to WP:MEDMOS an etymology section would be at the end of the article. My view is that terminology should be explained as early as possible in the article, especially where the explanation is only a single sentence. JFW &#124; T@lk  15:48, 26 September 2019 (UTC)


 * I agree that it should be explained as early as possible, that's why I put it in its own section at the top of the article, as chances are that a not inconsiderable amount of people would be reading this page asking WHY it's called that in the first place. Putting it at the top, in its own section for efficiency.--Satani (talk) 18:08, 26 September 2019 (UTC)


 * I'd sort of worked that out, but why do you think it should not be in the introduction? JFW &#124; T@lk  20:35, 26 September 2019 (UTC)


 * Because it gets kinda lost in the main intro, and to me seems like it'd warranted at least its own paragraph, i.e. the intro is all about the actual disease, and then tacked on seemingly as a "oh btw" is the naming description of something that has quite an unusual name, at least from a Western perspective.--Satani (talk) 20:46, 26 September 2019 (UTC)


 * I'd say it should be closer to the beginning of the intro, perhaps at the end of the first paragraph when the apical ballooning has been discussed. What do you think? JFW &#124; T@lk  08:29, 27 September 2019 (UTC)

Linked to moderate-to-severe emotional neglect in early childhood (4/2020)
http://www.heartmindjournal.org/article.asp?issn=2468-6476%3Byear%3D2020%3Bvolume%3D4%3Bissue%3D1%3Bspage%3D12%3Bepage%3D20%3Baulast%3DGoetzmann&fbclid=IwAR0QVqu7D23zC_bFXk41qFFMMMvtCmfDhBMGj98QHI6bILH6hiR6_BW4rnE

Adverse childhood experiences and the structure of personality in patients with takotsubo syndrome versus myocardial infarction — Preceding unsigned comment added by 2003:CB:BF17:EB00:FCE0:FA6F:A675:945F (talk) 14:53, 10 July 2020 (UTC)

small size 7/2020 study suggests a strong increase since covid-19 (non-infected individuals)
https://edition.cnn.com/2020/07/09/health/broken-heart-syndrome-coronavirus-wellness/index.html?utm_content=2020-07-09T22%3A00%3A54&utm_source=fbCNN&utm_term=link&utm_medium=social&fbclid=IwAR0WpqdxDbkFv7ylHI7UUO9nSDwc-w-wNCzAJcyPC_EaW4MxrYsvz01qgoI

Questionnable study design (see end of article)

2021 study
"Sex-and Age-Based Temporal Trends in Takotsubo Syndrome Incidence in the United States" (JAMA) Mapsax (talk) 22:17, 22 October 2021 (UTC)