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Artist’s Statement: Takotsubo Cardiomyopathy

Ahmed, Mohammed MD

doi: 10.1097/ACM.0000000000002827
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M. Ahmed is a first-year resident in internal medicine, Washington University in St. Louis, St. Louis, Missouri. The author was a fourth-year medical student, Oakland University William Beaumont School of Medicine, Rochester, Michigan, at the time of writing; moapeople@gmail.com.

During my cardiology rotation in my fourth year of medical school, I encountered and cared for my first patients presenting with takotsubo cardiomyopathy. The pathophysiology, which remains unclear, fascinated me. Its history and name presented an opportunity for me to visualize the human body through the lens of nature, as reflected in my drawing Takotsubo Cardiomyopathy, which appears on the cover of this issue.

Takotsubo cardiomyopathy commonly presents with symptoms of a heart attack—substernal chest pain, diaphoresis, dyspnea—with evidence of myocardial injury on blood tests and electrocardiography.1,2 However, unlike a myocardial infarction, this condition is not caused by an acute blockage of the coronary arteries that supply the heart.2 On echocardiography, takotsubo cardiomyopathy characteristically exhibits ballooning of the left ventricle and hypokinesis.1 Takotsubo, Japanese for “octopus trap,” became eponymized to describe this phenomenon. A patient with this condition has a heart with a dilated left ventricle, forming a distended apex and sharing great semblance to a trapped octopus.1,2

My intention with this piece was to depict the similarities between the heart with takotsubo cardiomyopathy and the octopus. The octopus’s body and tentacles are mirrored by the heart and associated major blood vessels. The effect creates parallels between seemingly different phenomena. I have highlighted contextual differences by depicting each environment in a background of inherent colors, with blue representing the ocean and red representing blood and viscera. However, despite the contrast, I also wanted to convey the unifying theme of nature, hence the continuity and merging of each half into the other. I digitally hand drew the piece using a pen tablet and sketchbook. The expanded color palette I accessed on the tablet was instrumental in displaying a wide range of lights and facades to each component, highlighting the intricacies within each element.

Illustrating similarities between the natural environment and the human body, like in my drawing Takotsubo Cardiomyopathy, is a recent endeavor, born out of my appreciation for nature’s overall influence on medicine. This observation was important for my clinical role because it allowed me to acknowledge patients’ pleas for natural alternatives to current pharmaceuticals. Despite my legitimate concerns with natural remedies, I found that having a thoughtful conversation with patients about their role and efficacy was a better approach than pitting medicine against nature to discredit patients’ claims. In perhaps a quest to reconcile the existing disconnect between nature and medicine, I opted to illustrate their similarities, mainly to remind myself that medicine is only a small part of nature.

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References

1. Akashi YJ, Goldstein DS, Barbaro G, Ueyama T. Takotsubo cardiomyopathy: A new form of acute, reversible heart failure. Circulation. 2008;118:2754–2762.
2. Pelliccia F, Kaski JC, Crea F, Camici PG. Pathophysiology of takotsubo syndrome. Circulation. 2017;135:2426–2441.
Copyright © 2019 by the Association of American Medical Colleges