Takotsubo or Stress Cardiomyopathy

Abstract

Many case reports have been published of reversible left ventricular dysfunction precipitated by sudden emotional stress. We have evaluated 10 women hospitalized for acute chest pain and dyspnea, mimicking an acute coronary syndrome, after a severe emotional trigger. Those patients, postmenopausal women, presented ST segment alterations on the EKG, minor elevations of cardiac enzymes, and biomarkers levels. At the coronarography there was not coronary thrombosis or severe stenosis, but the ventriculography showed wall motion abnormalities involving the left ventricular apex and midventricle, in the absence of significant obstructive coronary disease. The course was benign without complication, with a full recovery of left ventricular function in some weeks. These observations, like other reports, demonstrate the impact of emotional stress on left ventricular function and the risk of cardiovascular disease. The cause of this cardiomyopathy is still unknown, and several mechanisms have been proposed: catecholamine myocardial damage, microvascular spasm, or neural mediated myocardial stunning.

Takotsubo cardiomyopathy: how much do we know of this syndrome in children and young adults?

“…To date, many cases have been described worldwide, indicating that the cardiomyopathy is extremely unlikely to be geographically isolated. 3 As awareness of the syndrome has increased, more case reports have been published, the majority in adults, leading to its incorporation into the classification endorsed by the American Heart Association for reversible cardiomyopathies. 4 The prevalence of the syndrome is unknown, especially in children, but based on experience in adults it accounts for around 2% of patients with suspected acute coronary syndromes.…”

“…34 Recommendations made for adults, in the emergency setting before coronary angiography, are basically focused on the management of myocardial ischaemia as the first line of treatment, with continuous electrocardiographic monitoring, along with administration of heparin, oral and intravenous nitrates, and β-blockers. 3 In adults with low cardiac output syndrome and cardiogenic shock, mechanical support with intra-aortic balloon pump has been preferred to intravenous inotropic agents, the latter having deleterious effects in the setting of catecholamines excess. 19 Takotsubo cardiomyopathy, nonetheless, is a diagnosis of exclusion in adults, as it is difficult to ignore myocardial ischaemia as responsible for the constellation of symptoms.…”

Takotsubo Cardiomyopathy Shortly Emerged after Falling through the Ice - A Case Report

“…Kume et al have described elevated levels of catecholamines as the cause of cardiomyopathy. There are a lot of studies confirming the increased level of catecholamine in Takotsubo cardiomyopathy in compared with myocardial infarction [12,13].…”

Romantic Breakup Distress, Betrayal and Heartbreak: A Review

“…Although the heartache mimics symptoms of a heart attack, those with broken heart syndrome typically recover faster. Cardiac contractile abnormalities and heart failure have been recorded by several investigators following acute emotional stress [20,85]. Angiograms, however, revealed no clogged arteries in heartbreak, unlike real heart attacks.…”