Broken hearts and octopuses

A condition of our ticker has an eerie resemblance to a contraption that Japanese fishermen use 

September 25, 2022 12:01 am | Updated 12:01 am IST

Japanese always think of simple, out-of-the-box solutions to complex problems. While the Westerners use deep mechanised trawlers with scanners and radio communication on board, the Japanese use a cheap leather sack, with a rope loosely tied along its narrow neck. Drop it down, many at a time, and wait on the boat.

Octopus catching is an art in Japan. The narrow neck of the sack provides enough space for the octopus to go inside, with its eight limbs neatly tucked like a perfect ponytail. Bur once the octopus is trapped inside the sack, she panics. She tries to retreat quickly, and her trademark limbs prevent her from doing so. The more she struggles, the stronger is the pull on the rope, virtually closing her off like a purse string inside the sack. Sitting on the boat on the surface of the sea, all that the fisherman has to do is to pull up the shaking contraption. And wait for the next bait. The Japanese call the contraption takotsubo named after its peculiar shape of a narrow neck and wide belly.

The lady aged 40 had no significant past medical history and had two children. Her brother, an active 30-year-old, had gone out on his motorbike for a evening outing. The two-wheeler hit a median at a breakneck speed that broke his neck. He was brought to hospital, breathing but brain dead.

That is when her problems started. She was hysteric. She fainted, and then complained of some chest heaviness and breathlessness.

The emergency room duty doctor called me: “The brain-dead bike-accident man’s sister…”

“Effect of stress, give her some sedative and some IV fluids and she should settle down,” I said.

But she didn’t.

Only when her BP fell and oxygen saturation dropped, the duty doctor realised that there was something wrong.

The ECG stunned us, showing the changes consistent with an extensive myocardial infarction (heart attack). A blood test that confirms heart attack (troponin) came as positive. Heart attacks are distinctly rare in women, especially of a young age and those who don’t have diabetes.

It was past midnight; it took quite a lot of convincing her relatives who were already in shock. Media reports of inappropriate and unnecessary angiogram and angioplasty perhaps added to the confusion. Finally, after an hour, the family gave the go-ahead. An angiogram showed normal, clean coronary arteries (no blocks). A bedside echo showed that the left ventricle (the main pumping chamber in the heart) showed the typical narrow neck and dilated body — exactly like the leather contraption that the Japanese fishermen use.

It is then that we realised that this was a case of stress cardiomyopathy, now known as the takotsubo syndrome (aka broken heart syndrome). Recognised a decade ago, this condition mimics a heart attack (chest heaviness, ECG change, troponin positive) but differs in having a normal coronary angiogram and a takotsubo-shaped ventricle. With supportive therapy, most tend to do well and recover. This syndrome occurs as a result of sudden release of stress catecholamine hormones that damage the heart. In India, the most common precipitating reasons are death of a family member or close ones, unexpected loss of money in business and family abuse.

Recently, we got a young boy with takotsubo who was deeply upset when his parents forced him to change his school.

Stress hormones are meant to make our heart pump stronger and faster, to deal with an emergency. Inordinate and sudden surge of a huge dose of such catecholamine hormones causes the takotsubo syndrome.

Sometimes we spend time and money to get instant stress. Look at the theme parks and roller coaster ride, and you would realise that the stress hormone is a multi-million-dollar business. But believe me, there has not been even a single case of takotsubo syndrome on a roller coaster. Go ahead and enjoy yourself.

I am extremely scared of spiders and heights and lots of other things, and opt to sit out, watching the handbags and water bottles, as my wife and children enjoy those rides.

I just don’t want to be the first case report of a roller-coaster-induced takotsubo in the world.

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