Stress Cardiomyopathy (Takotsubo Cardiomyopathy)

Abstract

Background: Due to the rise in the number of reports of stress cardiomyopathy in the literature, awareness of this condition is increasing. Although different names have been used to describe this condition, the similarities in clinical, electrocardiographic, echocardiographic, and angiographic features suggest that they represent the same spectrum of diseases with different underlying causes. The pathophysiology of stress cardiomyopathy remains controversial. Methods:We describe a series of four cases of stress cardiomyopathy admitted to our institution over a period of six months with different presentations, but similar clinical course, EKG, echocardiographic, and catheterization findings. The ages ranged from 22 to 81 years; all four females. All showed characteristic wall motion abnormalities by imaging in the absence of significant coronary artery disease, with spontaneous recovery of left ventricular function with conservative therapy.Results: Although the patients presented with different clinical scenarios, all four showed characteristic features of stress cardiomyopathy suggesting that the pathophysiology affecting the myocardium was the same. We present a review of the literature with a discussion of the history of this condition, characteristic clinical features, and diagnostic criteria used in the past as well as the suggested pathophysiology of this condition. Conclusion:Stress cardiomyopathy is an underdiagnosed reversible cardiomyopathy triggered by severe emotional or physical stress. It represents a spectrum of conditions with reversible severe left ventricular systolic dysfunction that includes neurogenic cardiomyopathy. It is not confined to the Japanese population and can affect people of any ethnic background or nationality.

Epinephrine: A Short- and Long-Term Regulator of Stress and Development of Illness

“…Emotional, physiological, and physical stresses have also been implicated in acute and chronic cardiomyopathies that induce cerebrovascular changes that can lead to sudden death. While the underlying pathophysiology remains to be elucidated, it is known that adrenergic-mediated changes, e.g., epicardial vasospasm, microvascular dysfunction, hyperdynamic contraction, are due to the direct action of the catecholamines on cardiomyocytes (Abraham et al 2009;Dimsdale 2008;Esler 2010;Fineschi et al 2010;Khouri and Imran 2009;Mausbach et al 2010;Zeb et al 2011). Abraham et al (2009) described a ''syndrome of stress cardiomyopathy,'' which is elicited by intense emotional or physical stress, produces transient cardiac dysfunction and is thought driven by excessive sympathetic stimulation.…”

An Uncommon Case of Recurrent Midventricular Takotsubo Cardiomiopathy

“…Takotsubo cardiomiopathy was originally described by Japanese authors in 1990s, as a cause of myocardial infarction with nonobstructive coronary arteries disease and characterized by severe LV disfunction that typically recovers spontaneously within days or weeks. The name was attributed to the appearance of the LV during the systole in ventriculography, which resembles a takotsubo, a pot used by Japanese fishermen to trap octopuses [5].…”

Left ventricular plasty improved cardiac function in a case of takotsubo cardiomyopathy with persistent aneurysm

“…Several pathophysiological mechanisms such as multivessel coronary vasospasm, abnormal coronary microvascular function, and catecholamine-mediated cardiotoxicity [7,8] have been proposed to explain the causes of takotsubo cardiomyopathy. However, the precise etiology and pathophysiology of this unique syndrome remain unknown [9].…”