Cedars-Sinai Blog

Dr. Romana Herscovici - Understanding Takotsubo Cardiomyopathy

Romana Herscovici, takotsubo, stress cardiomyopathy, broken-heart disease

Dr. Romana Herscovici is a research fellow at the Cedars-Sinai Heart Institute working with the Cardiac Intensive Care Unit and the Barbra Streisand Women's Heart Center. She came here from Sheba Medical Center in Israel, and her research focuses on takotsubo, or stress-induced, cardiomyopathy, which predominantly affects women. Dr. Herscovici answered a few questions about her past and her goals in women's heart health.

Q: What led you to medicine?

Dr. Herscovici: When I was a child in a small town in Romania, my grandfather was diagnosed with an advanced metastatic cancer. I was only 9 and I saw him in a lot of pain. The last thing I said to him was, "I want to be a doctor so I can help other people avoid the suffering that you've had to endure."

At the time, I didn't understand the full implication of my words, but it was my last conversation with him and it wrote my future in medicine.

Q: How did you come to Cedars-Sinai?

Dr. Herscovici: After finishing medical school, I started my medical training at Sheba Medical Center in Israel with the goal of becoming a general surgeon. During the internship, I did a rotation in cardiac intensive care and I met mentors who made me fall in love with it.

My passion for intensive cardiac care and treating women's heart disease led me to Cedars-Sinai, which is state-of-the-art in both areas. I am the fourth generation of cardiologists from Sheba to study at Cedars-Sinai, and I was given a great opportunity to learn in both clinical and research fields.

Q: How did you become interested in women's heart disease?

Dr. Herscovici: During my cardiology fellowship at Sheba, I discovered the growing field of women's heart disease and I was intrigued. Cardiovascular disease is the number one killer among women worldwide, causing 1 in 3 deaths each year, so there's a lot more to do.
I'm learning about specific approaches to women's heart disease—including methods of diagnosis and treatment—and these are things that I want to promote in Israel.

Q: How would you describe takotsubo cardiomyopathy?

Dr. Herscovici: The condition goes by many names: takotsubo, stress cardiomyopathy, and even broken-heart disease.

It's a form of acute heart failure that appears with similar symptoms as a heart attack, like chest pain and shortness of breath.

The majority of patients are postmenopausal women. The condition is usually tied to some sort of stress trigger that may be psychological, like extreme or sudden sadness or joy, or physical, like illness. In some patients, no trigger can be identified.

The condition is reversible, and most patients recover within weeks.

Q: What do we still have to learn about the condition?

Dr. Herscovici: We need more tools for early diagnosis in the emergency room because the symptoms are similar to a heart attack. We don't know why some patients develop this condition and why it appears predominantly in women. We know some patients have recurrent episodes of takotsubo, but we don't know how to prevent or predict those. Because the mechanism of the disease is not clear, there is no consensus on the exact treatment that should be used.

All of these questions are opportunities for research on this condition.

Q: How has your experience been at Cedars-Sinai?

Dr. Herscovici: I'm halfway through my 2-year fellowship, and so far, I've enjoyed everything about my time here. My career until now was mainly clinical, so I love the opportunity to be part of research.

Q: What other goals do you hope to achieve during your fellowship?

Dr. Herscovici: My goal is to learn about intensive cardiac care and women's heart disease so I can take that knowledge home with me and open a women's heart center at Sheba Medical Center in Israel.

Recently, a few cardiology centers in Israel have opened women-oriented clinics. I think this needs to happen worldwide, given what we know about gender differences in heart disease.

Q: What are your plans for the women's heart center in Israel?

Dr. Herscovici: We know that the way heart disease is expressed in women can be different than men—including the symptoms of heart attack. Some heart conditions (like takotsubo) are seen more in women. Furthermore, despite great improvements in treatment and falling rates of mortality after heart attack, fewer women survive compared to men. A recent study from Israel showed that mortality after heart attack was twice as high for women.

At Cedars-Sinai, I'm learning about specific approaches to women's heart disease—including methods of diagnosis and treatment—and these are things that I want to promote in Israel.

It's also very important to educate the medical community and the general population about gender differences in heart disease. Recognizing these, using adequate diagnostic tools, and giving proper and timely treatment can save lives.