Surreal digital illustration of the connection between heart and lungs in Takotsubo syndrome and pulmonary embolism.

When Heart and Lungs Collide: Understanding Takotsubo Syndrome and Pulmonary Embolism

Lena Kashyap in Health & Wellness December 2025 • 4 min read.

"A rare case study sheds light on the link between 'broken heart syndrome' and life-threatening blood clots, offering insights for women's health and early diagnosis."

Takotsubo syndrome (TTS), often poignantly referred to as "broken heart syndrome," is a temporary heart condition that mimics a heart attack. It's typically brought on by periods of intense emotional or physical stress. But what happens when this cardiac condition occurs alongside another serious threat, like a pulmonary embolism (PE)?

A recent case report published in BMC Cardiovascular Disorders explores just such a scenario, detailing the experience of an 86-year-old woman who presented with symptoms suggestive of both myocardial ischemia (reduced blood flow to the heart) and pulmonary embolism (a blood clot in the lungs). This case highlights the challenges in diagnosis and the importance of considering unusual triggers for TTS.

While pulmonary embolism has been previously noted as a potential trigger for TTS, the co-occurrence of these two conditions remains rare. This article dives into the details of this fascinating case, reviewing available literature to empower clinicians and individuals alike with a better understanding of this complex interplay.

Decoding the Case: A Perfect Storm of Cardiac and Pulmonary Distress

Surreal digital illustration of the connection between heart and lungs in Takotsubo syndrome and pulmonary embolism.

An 86-year-old woman sought emergency care, reporting chest tightness, shortness of breath, and back pain that had persisted for six hours. Initially, local hospital doctors diagnosed an acute anterior myocardial infarction (MI) and administered initial doses of aspirin and clopidogrel. However, the symptoms showed no signs of relief.

Her medical history revealed previous pulmonary tuberculosis and a 40-year smoking habit (which she had quit 16 years prior). Initial examination showed a stable blood pressure of 100/76 mmHg, a heart rate of 82 beats per minute, and a respiratory rate of 20/min. Routine lab tests revealed slightly elevated levels of troponin I (cTnI) at 0.041 ng/ml (normal range 0-0.02 ng/ml) and creatine kinase-MB (CK-MB) at 6.54 ng/ml (normal range 0-4.99 ng/ml).

Electrocardiogram (ECG) anomalies: Abnormal Q-waves in leads I, aVL, and V2-V9, ST-segment elevation in leads V2-V9, biphasic T-waves in V2-V9, and negative T-wave in V1.
Echocardiogram findings: Enlarged left ventricle (LV) of 53 mm, ejection fraction (EF) of 36%, decreased motion in the left ventricular walls, mild tricuspid regurgitation, and estimated pulmonary artery systolic pressure (PASP) of 51 mmHg.

Emergency coronary angiography (CAG) revealed stable coronary plaques but no acute plaque rupture. Further investigation into the medical history, including many years of pain in her right lower extremity, and weakness of the bilateral lower limbs, pointed to deep venous thrombosis. Ultimately, a chest computed tomography (CT) scan confirmed multiple pulmonary emboli in both pulmonary arteries.

The Bigger Picture: Implications for Diagnosis and Treatment

This unusual case underscores the importance of considering pulmonary embolism as a potential trigger for Takotsubo syndrome, particularly in older women with pre-existing risk factors like deep vein thrombosis or a history of prolonged immobility. While TTS and PE are rare occurrences, clinicians must maintain a high level of suspicion and actively seek out potential risk factors to ensure early diagnosis and timely intervention. With prompt and effective treatment, full recovery from TTS with PE is possible, highlighting the need for vigilance and a comprehensive approach to cardiovascular care.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1186/s12872-018-0953-7, Alternate LINK

Title: Takotsubo Syndrome With Pulmonary Embolism: A Case Report And Literature Review

Subject: Cardiology and Cardiovascular Medicine

Journal: BMC Cardiovascular Disorders

Publisher: Springer Science and Business Media LLC

Authors: Qi Jin, Qin Luo, Zhihui Zhao, Qing Zhao, Xue Yu, Lu Yan, Liu Gao, Zhihong Liu

Published: 2018-12-01

Everything You Need To Know

What is Takotsubo syndrome (TTS), and how does it relate to pulmonary embolism (PE)?

Takotsubo syndrome (TTS), often referred to as "broken heart syndrome," is a temporary heart condition that mimics a heart attack, typically triggered by intense emotional or physical stress. Pulmonary embolism (PE) is a life-threatening condition caused by a blood clot in the lungs. While the co-occurrence of TTS and PE is rare, this case study highlights that PE can potentially trigger TTS. It emphasizes the need for clinicians to consider both conditions, especially in patients with risk factors for either condition.

What were the key symptoms and diagnostic findings in the case of the 86-year-old woman?

The 86-year-old woman presented with chest tightness, shortness of breath, and back pain. Initial tests suggested a myocardial infarction (MI). Diagnostic findings included elevated troponin I (cTnI) and creatine kinase-MB (CK-MB) levels, along with electrocardiogram (ECG) anomalies such as abnormal Q-waves and ST-segment elevation. Echocardiogram findings showed an enlarged left ventricle (LV), decreased motion in the left ventricular walls, and a reduced ejection fraction (EF). Ultimately, a chest computed tomography (CT) scan confirmed multiple pulmonary emboli in both pulmonary arteries, pointing to the diagnosis of pulmonary embolism.

What risk factors were present in the case, and why are they significant?

The patient had several risk factors, including a history of pulmonary tuberculosis, a 40-year smoking habit, deep venous thrombosis, and prolonged immobility. These factors are significant because they increase the likelihood of developing pulmonary embolism (PE) and may make an individual more vulnerable to Takotsubo syndrome (TTS). Clinicians need to be aware of these risk factors to facilitate early diagnosis and timely intervention, especially in older women.

Why is it important for clinicians to consider pulmonary embolism as a potential trigger for Takotsubo syndrome?

Considering pulmonary embolism (PE) as a potential trigger for Takotsubo syndrome (TTS) is crucial because it allows for a comprehensive approach to diagnosis and treatment. Since the co-occurrence is rare, clinicians may initially focus solely on one condition, potentially delaying the diagnosis and treatment of the other. This case study underscores the need for vigilance, especially in patients with pre-existing risk factors. Early recognition of both conditions can lead to prompt and effective treatment, improving the patient's chances of full recovery.

What is the prognosis for patients who experience both Takotsubo syndrome (TTS) and pulmonary embolism (PE), and how can it be improved?

With prompt and effective treatment, full recovery from Takotsubo syndrome (TTS) with pulmonary embolism (PE) is possible. Early diagnosis and intervention are essential. This involves considering the possibility of both conditions, especially in high-risk individuals, and utilizing diagnostic tools like ECG, echocardiograms, and CT scans to confirm diagnoses. Comprehensive cardiovascular care, including addressing the pulmonary embolism and managing the cardiac effects of Takotsubo syndrome, is key to improving outcomes. Continuous monitoring and a thorough assessment of underlying risk factors are crucial for preventing future complications.