Dr Cindy Towns
Takotsubo cardiomyopathy is thought to account for 1-2 percent of acute coronary syndromes (ACS), ACS being medicalese for what most people would call ‘heart attacks’.
Takotsubo as a diagnosis got its name from a Japanese Octopus pot which looks a little like the Takotsubo heart on echocardiography (essentially an ultrasound). Takotsubo has some more creative synonyms, including acute stress cardiomyopathy, broken heart syndrome and ‘scared to death’. It mimics a traditional heart attack but is not due to coronary artery disease. Rather, the structure of the heart balloons in places. Classically, physically or emotionally distressing events precede the presentation, but the exact mechanism of the condition remains speculative. It has been associated with earthquakes in both Japan and New Zealand.
I first encountered Takotsubo when I was working as a medical registrar. It was 3am on a busy night shift. The woman had chest pain, breathlessness and raised cardiac enzymes indicating heart damage. Her angiography showed no culprit lesions but her echocardiogram showed the classic ballooning of ‘broken heart syndrome’. The woman’s father had passed away unexpectedly a few hours prior to her presentation. I was struck by the intensity of the relationship between body and mind. The ancient connection of the heart to love seemed to be winding its way into medical practice that night…
Grand Rounds are part of medical tradition. A doctor in training (usually a registrar) presents an interesting case, does a literature review and presents herself for public grilling in a large lecture theatre. To be truthful, after the requisite nerves, I tended to enjoy them. It is one of the few arenas in medical training where ‘rote memorisation’ is of little value. Instead, preparation, a command of the spoken word and a sense of humour tended to put one in good stead for the weekly tradition.
I decided to present my Takotsubo case but soon found that I was struggling in my preparation. I lacked the ability to articulate what I felt was a profound relationship between health and love; illness and grief. My medical words were failing me…
… I contacted a poet and she made the connection for me. She wrote the words that I could not write and (with only a mild, acute attack of performance anxiety on my behalf…) we presented it together as part of my Grand Round. The combination of the poetic with the clinical remains a vivid and much loved memory of my long—and at times arduous—medical training. To my great delight the poem has also been set to music by composer Anthony Ritchie and was performed by Cantus Columba from Columba College (Dunedin) at the 2013 national secondary school choral festival, The Big Sing.
Thank you Sue and Anthony, and Kia Kaha Kaikoura.
Takotsubo – Anthony Ritchie (Cantus Columba)
Tako-tsubo – Sue Wootton, Out of Shape (Ampersand Duck, 2013)
A word on the poem: The four stanzas of “Takotsubo” represent the four chambers of the physical heart. As the poem progresses through these ‘chambers’, it descends through four levels of disturbance. The journey is from measurable physical disturbance to the deep emotional fracture which is the true cause of the surface damage.
Dr Cindy Towns: Cindy Towns is a General Physician and (almost) Geriatrician at Wellington hospital. She has a PhD in biomedical ethics and holds an adjunct senior lectureship at the Bioethics Centre, University of Otago.