Stress-Induced Cardiomyopathy: A Need for Prospective Multicenter Trials

Abstract

Stress-induced cardiomyopathy (also called Takotsubo cardiomyopathy, apical ballooning, or broken heart syndrome) was first reported in 1991 as stunning due to simultaneous multivessel coronary spasms: a review of 5 cases by Japanese doctors,1) and is well known disease entity now. This disease primarily affects postmenopausal women after psychological or physical stress.2) Clinical characteristics are a triad of sudden onset of chest pain or dyspnea, electrocardiographic findings with ST segment elevation and evolutional T-wave changes, and a moderate elevation in cardiac enzymes mimicking acute myocardial infarction.3) As a precaution, coronary angiography is usually performed to differentiate from acute coronary syndrome. Even though many case and clinical study reports have been published, the mechanisms of stress-induced cardiomyopathy (SCM) are still unknown. The pathophysiology of SCM is includes vasospasm of coronary arteries; disturbance of microcirculation; obstruction of the left ventricular outflow obstruction; catecholamine-mediated myocardial stunning, which is an important link between emotional or physical stress and cardiac injury; hormonal interactions; and inflammation.4-7)