Stress-induced cardiomyopathy: A review

Cocco, Giuseppe; Chu, D.

doi:10.1016/j.ejim.2007.02.021

Cited by 33 publications

(51 citation statements)

References 63 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Anatomical abnormalities regarding coronary arteries have also been observed in patients with takotsubo syndrome, i.e. myocardial bridging 64 and hypoplastis coronary arteries 65 , but there is no evidence to suppot a causative role.…”

Section: Acute Multivessel Coronary Spasmmentioning

confidence: 99%

Epidemiology and pathophysiology of Takotsubo syndrome

2015

View full text Add to dashboard Cite

Takotsubo syndrome is an acute cardiac syndrome first described in 1990 and characterized by transient left ventricular dysfunction affecting more than one coronary artery territory, and often in a circumferential apical, mid-ventricular or basal distribution. A number of pathophysiological explanations for this syndrome with its intriguing appearance have been proposed, and there is a growing awareness that these are not mutually exclusive, and that the reversible apical myocardial dysfunction observed could result from more than one pathophysiological phenomenon. The pathophysiology of takotsubo syndrome is complex, with integration of both neuroendocrine physiology involving the cognitive centres of the brain and hypothalamic-pituitary-adrenal axis, and the cardiovascular responses to the sudden sympathetic activation and surge in circulating catecholamines. The latter have been explored in detail, starting with the histological findings at biopsy, with the multiple morphological changes seen in the myocardium matching those seen after established catecholamine cardiotoxic effects. Clinically, both the acute prognosis and recurrence rate are unfortunately worse than previously reported. It is clear that the modern cardiology community has much still to learn regarding the epidemiology and the underlying pathophysiology of this fascinating condition in order to improve diagnostic and treatment pathways. 3 Key points Approximately 2% of all patients presenting to the hospitals with suspected acute coronary syndrome are usually identified with takotsubo syndrome. There is a predominance in post-menopausal women compared to men or younger women. Both the acute and long-term mortality are higher than previously recognized.The cumulative incidence of recurrence increased from 1.2% at first 6 months to nearly 5% at 6 years, and there is no current evidence to support treatment with any specific to prevent recurrence. Systemic surges in catecholamines may cause vascular effects including acute coronary vasospasm and severe acute hypertension due to acute peripheral vasospasm followed by later peripheral vasodilation and hypotension. In the clinical setting, profound hypotension and cardiogenic shock is a common complication, however, it is not solely related to the extent of impairment of left ventricular (LV) systolic function, and thus probably relates in part to inappropriate peripheral vasodilation. Biopsies during acute takotsubo syndrome are characterized by multiple morphological changes that are similar to those after catecholamine cardiotoxic effects supporting a direct effect in addition to the vascular influences. The apical myocardium of the left ventricle has the highest density of β-adrenergic receptors (βAR), and is therefore most sensitive to circulating catecholamines.

show abstract

Section: Acute Multivessel Coronary Spasmmentioning

confidence: 99%

Epidemiology and pathophysiology of Takotsubo syndrome

2015

View full text Add to dashboard Cite

show abstract

“…Etiological heterogeneity and prominent contribution of co-morbidities make understanding the pathophysiology of CSX particularly challenging [6,7,[9][10][11][12][13][14][15][16]. It has been, however, established that the interplay of multifactorial mechanisms (Table 1) may cause myocardial ischemia and AP in patients without flow-limiting coronary stenosis, i.e.…”

Section: Pathophysiology Of Ischemia and Ap In Csxmentioning

confidence: 99%

“…Many pathologic mechanisms may induce CAS which is a proven cause of myocardial ischemia and AP [13,21,[24][25][26][27][28][29][30] and is the 3 rd etiologic mechanism in CSX [13]. CAS is linked with some genetic background [9,10,23,24]. In CSX-patients CAS has been linked with an ACS in > 50% of cases [26,29,30] and was thought to be the cause of myocardial infarction in some cases [24,30,31].…”

Section: Pathophysiology Of Ischemia and Ap In Csxmentioning

confidence: 99%

“…There was a strong bias in evaluating women with CHD, however, at present coronary angiography is rapidly performed in women with suspected CHD. It has been now seen that nearly 75% of women with typical AP have no flow-limiting epicardial coronary pathology [11][12][13][14][15] and depending on different registry data this cardiac situation is also found in 5% to 15% of men [10,13,16,21]. It must thus be accepted that millions of people (mostly women) with AP without flow-limiting coronary pathology will probably be identified each year.…”

Section: Epidemiology Of Csxmentioning

confidence: 99%

“…perspiration, tachycardia and dizziness) without epicardial coronary artery pathology. This pathology is not rare and is often termed 'cardiac syndrome X' (CSX) [6][7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations