Associated triggers

Typically there is a history of an acute physical or emotional stressor within the preceding hours/few days that triggers TTS, but approximately one third of people have no identifiable trigger at the time of presentation.

  • Emotional triggers vary in nature, ranging from what may be perceived by others to be a trivial event (loss of a personal item) to a life-changing event (death of a loved one).
  • TTS can also be triggered by positive emotional events such as winning a prize, or happiness at a celebration of a birthday, wedding or family reunion).  The magnitude of the event does not appear to be the determinant of TTS occurrence. Any event that causes acute emotional stress in a susceptible individual can trigger TTS.
  • Physical stressors, usually in the form of acute illness, trigger around 40% of TTS cases. As with emotional stressors, there is a wide range of physical stressors that have been associated with TTS. When TTS occurs secondary to physical illness it is known as secondary TTS.
  • Several pharmacological substances have been reported as triggering TTS. CLICK HERE for more information about this.

Examples of stressors that have been associated with the development of Takotsubo syndrome

Negative emotional stressors
affecting individuals

Grief/Loss

  • Bereavement
  • Friend moving away
  • Loss of home
  • Loss of job
  • Loss of pet
  • Relationship breakup
  • Sports team loss

Conflict

  • Arguments
  • Bullying/harassment

Panic/fear/anxiety

  • Illness of a loved one/pet
  • Restraint in custody
  • Accident (transport)
  • Fall
  • Robbery
  • Physical threat
  • Illness or impending surgery
  • Nightmare
  • Public speaking

Financial concerns

  • Debt

Negative emotional stressors
affecting populations

  • Earthquake
  • Tsunami
  • Bush Fires
  • War

Examples of positive emotional
events
affecting individuals

  • Lottery/casino win
  • Parties/ celebrations
  • Becoming a grandmother
  • Reunions with friends or family
  • Favourite team/sports person win
  • Enjoyment of music/theatre

Examples of physical stressors

  • SCUBA diving
  • Near drowning

Examples of medical physical stressors

Neurological disorders

  • Subarachnoid haemorrhage
  • Epilepsy
  • Ischaemic stroke
  • Migraine
  • Intracerebral haemorrhage
  • PRES
  • ALS
  • Trauma
  • Encephalitis/myelitis
  • Hydrocephalus
  • Hepatic encephalopathy
  • Subdural haematoma
  • Brain tumour
  • Venous aneurysm
  • Multiple sclerosis

Respiratory causes

  • Acute asthma and airways disease
  • Pneumonia
  • Respiratory failure

Medical/dental procedures

  • Surgery and anaesthesia
  • Insertion/removal tracheal tube
  • Cardiology diagnostic procedures

Mental health-related  disorders

  • Acute anxiety/panic attack
  • Illicit drug use
  • Drug-withdrawal syndromes
  • Attempted suicide (hanging/drug overdose)

Endocrine disorders

  • Thyrotoxicosis
  • Addisonian crisis
  • Pheochromocytoma

Other

  • Childbirth
  • Infection/sepsis
The story of the Christchurch earthquakes and Takotsubo Syndrome.
Christchurch is the second largest city in New Zealand.  In September 2010, Christchurch was struck by a 7.1 magnitude earthquake at 4:46 in the morning.  Although there were no direct fatalities, there was significant damage to the city’s infrastructure and buildings, large financial losses and major disruption to normal living activities for many. Six women (average age 72 years) were admitted to the city’s hospital with TS related to the stress of the earthquake.  There were thousands of mild to moderate aftershocks, until six months later, when another powerful earthquake (magnitude 6.3) again struck Christchurch. Around 185 people were killed, many more injured and left homeless, and with a third of the CBD’s buildings destroyed. Following the second earthquake, 21 women (average age 68 years) were admitted within 4 days of the event with TS.  TS seemed to occur only with the two large earthquakes and no cases of TS were recorded during the period of magnitude 5 to 6 aftershocks.1

Reference

1Chan, C., Elliott, J., Troughton, R., Frampton, C., Smyth, D., Crozier, I. and Bridgman, P., 2013. Acute myocardial infarction and stress cardiomyopathy following the Christchurch earthquakes. PloS one, 8(7), p.e68504.