Antiochus I Soter may have suffered from takotsubo cardiomyopathy due to unrequited love of Strotonikea in the perspective of modern medicine

Takotsubo cardiomyopathy (TCM), also known as the “broken heart syndrome”, is a transient cardiac syndrome involving left ventricular apical akinesis; the condition mimics acute coronary syndrome. Its name is derived from the Japanese word takotsubo, a device Japanese fishermen use to catch octopus (Figure 1 A). The device has a round bottom and narrow neck, resembling the apical left ventricular ballooning [1]. TCM commonly occurs in elderly postmenopausal women aged 65 to 70 years. In contrast, the incidence in males seems to be higher in studies from Asia, ranging from 13% to 35% [2]. The disease has a reversible course and concerns systolic and diastolic left ventricular dysfunction with various wall motion abnormalities. It usually results from emotional distress, natural disasters, and the death of a loved one. The brain-heart axis has been defined in its pathophysiology with catecholamine excess [3].
Known as the ancient city of eternal love and gladiators, Stratonikeia sits on the border of the Village of Eskihisar and Yatagan, Mugla in Turkey (Figure 1 B). One of the most significant city-states in Caria, Stratonikeia, has been inhabited since the Late Bronze Age to the present day. Stephenus of Byzantium (6th century AD) tells us the fascinating story of a hopeless love and disappointment. The son of Seleukos I Nikator, the King of Caria, Antiochus I Soter (324–261 BC) [4] fell in love with his father’s beautiful wife, Stratonikeia. However, this forbidden love caused much agony, and Antiochus fell ill. The King invited doctors from all around the country to find out what caused the ruthless disease. Alas, all the attempts to figure out the enigma failed. As Antiochus’ condition got worse by the day, the King agonized over his boy’s condition and summoned the famous doctor named Erasistratus of Ceos (304–250 BC). Erasistratus is known as the first cardiologist mentioned in written literature since he was the first to describe the heart as the blood pump as well as the heart valves, heart rhythm, and vessels supplying the heart [5]. Erasistratus observed Antiochus for days, and he noticed that when Stratonikeia visited Antiochus’ room, Antiochus’ condition became worse, and his pulse increased. He experienced shortness of breath, chest pain, and his face blushed. Erasistratus diagnosed Antiochus’ condition as hopeless love and told the King that there was only one remedy to cure him of his grave predicament (Figure 1 C). The King had...


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