Have you ever confused coriander with parsley? Or avocado with wasabi?
Green foods can disguise to perplex the brain.
This happened with a 60-year-old Israeli woman who was happily attending a wedding when she mistook wasabi for avocado, maybe due to her ravenous hunger. Large consumption of wasabi twisted the scene. Within a few minutes, she suddenly developed acute chest pain radiating to her arms.
She was hospitalised the following day. Complete examination and tests were conducted and she was diagnosed with ‘Takotsubo cardiomyopathy’ or ‘Broken heart syndrome’. The latter name is attributable to its usual triggers: emotional stress or physical exertion. She was treated with ACE inhibitors and beta-blockers. A complete recovery was seen during the next follow-up.
What was the triggering factor in the woman in the discussion here? She was at a wedding party!
Everything was good until she ingested wasabi. If you are a sushi lover, you may be aware of wasabi’s spicy taste, as it is usually served with sushi to add flavour.
Here the culprit is the super spicy stimulus from wasabi which flooded the stress pathways leading to acute chest pain.
Takotsubo cardiomyopathy (TCM) is primarily characterized by reversible and transient left ventricular (LV) ballooning. Coronary arteries remain normal. It is seen more commonly in postmenopausal elderly, white women (indicating some role of estrogen in the aetiology). After a triggering event, transient hypokinesis of the left ventricular (LV) apex occurs but this wall motion abnormality resolves within a few days to weeks.
Symptoms of broken heart syndrome resemble that of a heart attack – angina, palpitations, shortness of breath, etc, then what’s the difference between the two?
Heart attack causes permanent damage, whereas the dysfunction due to broken heart syndrome is temporary. Usually, patients make full recovery in a month.
Treatment is symptomatic with adrenergic blockade being the primary goal. In practice, angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) are given until the left ventricular function is restored. β-blocker, α-adrenoceptor agonist or calcium channel blockers can be considered.
Although the prognosis is good, yet some complications may ensue such as hypotension, heart failure, ventricular rupture, etc.
The name takotsubo cardiomyopathy has a Japanese origin. In Japanese ‘takotsubo’ means a fish pot which has a narrow neck and a round bottom. Heart affected with TCM acquires this shape as seen during systole on ventriculography, hence the name.