
Takotsubo cardiomyopathy triggered by wasabi consumption - johanam
https://casereports.bmj.com/content/12/9/e230065.full
======
King-Aaron
> a case of a 60-year-old woman that presented to the emergency department
> with chest pain after she attended a wedding and ate a large amount of
> wasabi, assuming it to be an avocado

It should probably be cleared up that she suffered left ventricular
dysfunction from eating too much wasabi - I had originally read the title
thinking she was emotionally distressed from not getting her avocado, but
instead it's more like a nervous system shock from the wasabi/wasabi
poisoning(?) itself?

~~~
rr-geil-j
I'm interested if this can indeed be categorized as 'poisoning'. If I
understand it correctly, what the wasabi did is similar to what extreme
emotional stress can also do... So if the effect of too much wasabi is
considered 'poisoning', can extreme emotional stress be considered a poison?

~~~
missosoup
I don't think we're talking about emotional stress here. Eating a teaspoon of
wasabi is comparable to eating a teaspoon of habanero chilli sauce. It's a
shock to the nervous system unless you have a tolerance.

~~~
rob74
Yeah, but the effects can be the same as those of extreme emotional stress,
i.e. you start crying...

~~~
missosoup
I think crying is a bit of a red herring here.

Chilli and wasabi doesn't make you cry in the emotional sense. They stimulate
the sinus and lacrimal glands to dilute and flush the irritant. There are
other non-emotional triggers such as cutting onions. In that case we 'cry' to
dilute and flush the sulphuric acid formed on the eye.

~~~
Bartweiss
It's interesting to note that this isn't just a difference in cause. The
actual chemistry of tears changes based on trigger, which means there's an
objective difference between crying from the pain of a hot pepper and tearing
up as a physical reaction to it. (And this shouldn't be totally surprising;
any mammal tears up at eye irritants like onions or dust, so humans obviously
have some additional mechanism controlling emotional tears.)

In fact, we apparently have (at least) four different types of tear! 'Basal'
tears that keep our eyes wet have much higher lipid levels than any other
type, and a higher fraction of their lipids are nonpolar. 'Reflex' and 'flush'
tears are similar, they're both responses to irritants, but there seem to be
differences between tears produced to remove solid/physical and liquid
irritants. And then 'emotional' tears (which include pain) come with a host of
hormones and other proteins basically absent from the general tear responses.

------
tanr54ok
I’m curious with something as poorly understood as takotsubo, how they are so
confident to rush to the conclusion that the wasabi must have triggered. I
actually read the full text and I dont see any discussion on eliminating
confounders, and this is just one case.

At best this suggests further research is in order, but I’m not convinced
anything can be definitively concluded here about the cardiotoxicity of
wasabi.

Case report or not, what passes for medical research makes me shake my head.

~~~
carbocation
As a cardiologist, this is also my perception (that you can’t assign causality
to wasabi here).

Not bad to put out a case report, since if there is truth here, this could
spur future knowledge. But it seems unlikely that wasabi was causal compared
to, say, the wedding itself.

~~~
mywittyname
Aside: now does a cardiologist become a member of Hacker News?

~~~
teej
There are a bunch of physicians of different specialties in this community.
It’s not uncommon.

~~~
bookofjoe
Hear, hear: neurosurgical anesthesiologist (retired) here

------
lioeters
Since no one has mentioned it yet, the etymology of the phrase:

The name "takotsubo syndrome" comes from the Japanese word takotsubo "octopus
trap", because the left ventricle of the heart takes on a shape resembling an
octopus trap when affected by this condition.

------
woadwarrior01
This is very reminiscent of something which happened to a friend of mine a
couple of years ago. She'd never eaten Japanese food before and I took her to
a local sushi joint. She mistook wasabi for guacamole and ended up putting a
large lump of it in her mouth. Fortunately, I noticed it immediately and asked
her to spit it out, and by then her eyes were already teary and her breathing
was quite labored. She didn't at first, perhaps because she was concerned
about the embarrassment it'd cause. I had to repeat again, this time adding
that she shouldn't be worried about anything and just spit it out and she did.
Finally, rinsing the mouth with a jug full of cold water and eating some Gari
(the pickled sweet ginger that's served with Sushi) alleviated her symptoms.

I texted her the link to this hinting that I might have saved her life that
day. Evidently, she still avoids Japanese food, thanks to that incident.

------
rconti
My parents are both very healthy; my dad's 80 and my mom is in her early 70s.
They're typically mistaken for much (10-20 years) younger.

So it was quite a shock to hear my mom was in the hospital for a heart issue a
couple years back.

She was ultimately diagnosed with Takotsubo.

They had been watching a play at an outdoor theater, and during a very
stressful/dramatic/revealing moment in the play (I think with loud drums,
etc), she had these chest pains and was rushed to the hospital.

Very interesting to learn about this condition I hadn't heard of. The "good
news" is that, if you recover, and go a few weeks (I want to say 6+) without a
recurrence, the heart re-strengthens and you're not any more likely to have
heart issues again than anyone else.

[https://en.wikipedia.org/wiki/Takotsubo_cardiomyopathy](https://en.wikipedia.org/wiki/Takotsubo_cardiomyopathy)

------
comex
Mirror: [https://a.qoid.us/takotsubo.pdf](https://a.qoid.us/takotsubo.pdf)

------
SketchySeaBeast
I don't have access to the full article, but my only real question is - HOW? I
don't know how you'd mistake a mouthful of wasabi for anything, except maybe
trying to swallow a flamethrower. I can't imagine getting through the first
mouthful and then moving on to the "eating a large amount" stage.

------
bookofjoe
[http://archive.is/XsDrq](http://archive.is/XsDrq)

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not_a_cop75
If I know anything about trending, there's going to be a few new Youtube
channels now dedicated to wasabi ingestion, hopefully complete with medical
personnel available if something should go wrong.

------
agumonkey
Cardiologist takotsubo wasn't real.

~~~
howard941
I can't read the full article and I'm not a physician: Doubly handicapped. Why
do you say it wasn't real?

~~~
agumonkey
sorry I sadly forgot a verb. "cardiologist said takotsubo wasn't real" (not my
opinion)

~~~
carbocation
What rationale did they give for that? There is a fair body of literature that
they'd be overturning if they can show that stress cardiomyopathy, which we
see often, is not real.

~~~
agumonkey
I didn't ask more I was already too frustrated.

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anon9001
I just assume everything has some small chance of killing me and try not to
let it bother me too much.

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black_puppydog
Every time boulevardesque stuff like this gets too prominent on the HN
frontpage, I go do a deep dive into daily politics to see if there is anything
that is being buried.

------
lbj
As a hacker, Im struggling to see how this is relevant to me?

~~~
2rsf
don't you eat when you hack ?

~~~
lbj
No. But even so, a rare fringe case of someone mistaking wasabi and
avocado.... I have a feeling I'll make it to 80 years of age without that
happening.

~~~
nickkell
You will now that you've got the benefit of reading about this case

