Pathophysiological Mechanisms of Takotsubo Cardiomyopathy - a Systematic Review

Pathophysiology of Takotsubo Cardiomyopathy

Abstract

Takotsubo cardiomyopathy, also referred to as stress-induced cardiomyopathy, is an acute condition associated with transient left ventricular dysfunction. Since it can be induced by increased emotional stress (such as losing a loved one, or constant anxiety) it is also called Broken Heart Syndrome. This type of cardiomyopathy is described in all age groups and both sexes, but it is most common in postmenopausal women. There are several clinical manifestations such as chest pain, sometimes with heart failure, and often with ST-segment changes that may present as acute coronary syndrome. It is characterized by absence of coronary artery obstruction, with transient regional wall motion abnormalities and minimal elevation of cardiac enzyme levels. Although wall motion abnormalities are reversible in almost all cases, long-term prognosis is excellent, but this condition is important because in acute phase it may cause sudden cardiac death. Mechanisms and cause of this disease remain still unclear. Some possible causes of this disorder include: 1) coronary artery vasospasm, 2) microcirculatory dysfunction, 3) transient obstruction of the left ventricular outflow tract, and 4) excessive release of catecholamines which seems to have most important role. The aim of this review is to summarize the most important pathophysiological mechanisms that may be responsible for the development of this type of cardiomyopathy.