Abstract
Stress cardiomyopathy, also referred to as Takotsubo cardiomyopathy, transient apical ballooning or broken heart syndrome, is a disorder associated with transient left ventricular dysfunction. Symptoms include acute chest pain and dyspnea accompanied by electrocardiographic changes, such as ST-segment elevation and T-wave inversions, minimal elevation of cardiac enzyme levels and transient wall-motion abnormalities in the absence of substantial coronary artery obstruction. Complete recovery of contractile function has been documented in nearly all cases, but the mechanisms of disease remain unclear and the cause has not been established. Coronary artery vasospasm, microcirculation dysfunction, and transient obstruction of the left ventricular outflow tract have been proposed as possible causes of this disorder. An excessive release of catecholamines also seems to have a pivotal role in the development of stress cardiomyopathy. This Review summarizes published data on stress cardiomyopathy, focusing primarily on the most likely causes of this cardiac entity.
Key Points
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Stress cardiomyopathy occurs in 0.7–2.5% of patients presenting with the symptoms of acute coronary syndromes
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Postmenopausal women are the group predominantly affected by stress cardiomyopathy
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Although the cause of stress cardiomyopathy is still unknown, excessive catecholamine levels have a major role in the pathology of this disorder
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Catecholamine overload results in substantial structural alterations, including increased extracellular matrix, contraction band necrosis, and mild neutrophil infiltration
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Stress cardiomyopathy is associated with increased oxidative stress and the alteration of Ca2+-handling proteins, which might be crucial for contractile dysfunction
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An activated cell survival cascade, such as the PI3K–AKT pathway, could protect cardiomyocytes from cell death and contribute to their rapid regeneration in patients with stress cardiomyopathy
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Nef, H., Möllmann, H., Akashi, Y. et al. Mechanisms of stress (Takotsubo) cardiomyopathy. Nat Rev Cardiol 7, 187–193 (2010). https://doi.org/10.1038/nrcardio.2010.16
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DOI: https://doi.org/10.1038/nrcardio.2010.16
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