Takotsubo Troubles

There's a medical condition in the literature known as Takotsubo Cardiomyopathy. It's basically broken heart cardiomyopathy where extreme grief or stress can actually lead to heart failure. It's been well documented in elderly widows who have chest pain or pressure at some point after losing their spouses. One of my favorite shows, "Scrubs," actually had the diagnosis as one of their story lines.



I think I might have written about the multitude of OD's we were seeing in the days following Thanksgiving (60 Hours), but lately it's seemed like I'm seeing a lot of depressed patients who come into the E.D. just for some companionship, or to have someone to talk to for a while. I did have two women who came in that made me think of Takotsubo's.

The first was a woman whose chief complaint was: chest pain. About 2 minutes after I started talking to her, I realized that her heartache was more of the emotional kind than the physical kind. She made a comment about all the "pressures" in her life at this time. When I pressed about them, she started crying and told me about how her fiance had died the year before, and how the holidays had always been a very special time for the both of them. They had been together for 8 years. She had family she wasn't really close to, and he had no one. They had each other.

She told me how she had seen him die right in front of her in a freak accident. One minute they were walking along, joking and laughing; the next, he had fallen down an embankment and died as a result of the fall. They had just gotten engaged and had not even gotten around to setting a date. I still had to work her up as a potential Acute Coronary Syndrome, but I ended up discharging her home with follow-up to counseling and psychiatry.

The second little lady came in this evening as I was trying to wrap things up at the end of my shift. Her chief complaint was "weakness." As I talked to her, she had some very non-specific symptoms: some nausea but no vomiting, some general feelings of "just being sick," and a feeling in her stomach that wasn't pain, and wasn't related to anything else. When I pushed her on it, she stated that she thought she might be lonely.

She lives in Senior Apartments. She doesn't like seeing ambulances coming and going at all hours. She's proud of her children and their accomplishments but calls them "work a holics" who don't have time to visit. She says her apartment is by the lake, but too much moisture which makes her bones ache. She said just being in the E.D. made her feel better. She told me that her physician told her that "loneliness will make you sick" and maybe that's all that is going on with her now.

When I signed her out at the end of my shift, I brought up Takotsubo's. My colleagues chuckled, but I'll think of this scene in "Scrubs" as I go to bed tonight; lying on a bed surrounded by three warm and purring kitties. Charles Schultz in "Peanuts" once said that "Happiness is a warm puppy." Too bad I can't write a prescription for a box of kittens or a warm puppy.