Abstract
Takotsubo syndrome (TTS), also known as stress cardiomyopathy, is a type of acute heart failure syndrome triggered by intense psychological or physiological stress. TTS typically manifests as acute chest pain, dyspnea or syncope that mimics an acute myocardial infarction but does not involve coronary artery obstruction. The current understanding of the pathogenesis of TTS suggests that sympathetic nervous system (SNS) activation plays a central role. Specifically, stress can activate the SNS and lead to the over-release of catecholamine, which have toxic effects on myocardial tissue when present at excessive levels. However, the brain changes associated with TTS and the connection between the brain and the heart in patients with this disease remain unclear. In recent years, several published reports have revealed the role of this brain-heart connection in the pathogenesis of TTS. This review summarizes recent studies regarding SNS activation, catecholamine overload, and the brain-heart connection in patients with TTS from both pathophysiological and mechanistic aspects.
Highlights
Takotsubo syndrome (TTS), which is known as stress cardiomyopathy, is an acute syndrome that is induced by psychological or physiological stress and characterized by acute reversible heart failure [1]
Her coronary arteries were normal, and apical ballooning gave the appearance of a traditional Japanese pot called a “Takotsubo.” She presented with marked abnormalities in ventricular motion that were visible on left ventriculography, which disappeared after 2 weeks [5]. ese interesting cases were first reported only in Asia, and the disease attracted gradual attention as western countries began to report similar cases in the late 1990s [6]
Current epidemiological data indicate that takotsubo syndrome (TTS) patients account for 1–3% of all cases of suspected acute myocardial infarction (AMI), and 90% of affected patients are Cardiology Research and Practice postmenopausal women [8,9,10], consistent with the observation that women older than 55 years have a 10-fold greater risk of TTS than men of the same age and a five-fold greater risk than younger women [11]
Summary
Takotsubo syndrome (TTS), which is known as stress cardiomyopathy, is an acute syndrome that is induced by psychological or physiological stress and characterized by acute reversible heart failure [1]. Most patients with TTS do not present with coronary artery occlusion, and such cases are characterized by reversible left ventricular dysfunction [3]. The first case involved a 64-year old woman with significant symptoms and ECG changes consistent with AMI. Her coronary arteries were normal, and apical ballooning gave the appearance of a traditional Japanese pot called a “Takotsubo.” She presented with marked abnormalities in ventricular motion that were visible on left ventriculography, which disappeared after 2 weeks [5]. Despite some severe and potentially fatal complications, including heart failure, cardiac shock, and malignant arrhythmias, the prognosis of TTS is generally favorable [13]
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