Too sympathetic? Role of sympathoexcitation in Takotsubo cardiomyopathy

Abstract

Takotsubo cardiomyopathy is classically described as sudden and transient left ventricular apical ballooning in the absence of significant coronary artery disease. First described by Dote et al, 1 Dote K. Sato H. Tateishi H. Uchida T. Ishihara M. Myocardial stunning due to simultaneous multivessel coronary spasms: a review of 5 cases. J Cardiol. 1991; 21: 203-214 PubMed Google Scholar the cardiomyopathy was named “Takotsubo” because the narrow neck and round-bottomed left ventricle resemble a traditional Japanese octopus trap. Since the initial description of the condition, patients with transient left ventricular dysfunction have been identified with both the typical apical ballooning (AB) pattern and an alternative mid-left ventricular ballooning (MB) pattern, the “inverted Takotsubo.” 2 Kurowski V. Kaiser A. von H.K. et al. Apical and midventricular transient left ventricular dysfunction syndrome (tako-tsubo cardiomyopathy): frequency, mechanisms, and prognosis. Chest. 2007; 132: 809-816 Crossref PubMed Scopus (432) Google Scholar Patients present with symptoms resembling those of acute myocardial infarction, including chest pain, ST-segment elevation, and elevated cardiac enzymes. A high proportion of patients are women who develop symptoms after episodes of high emotion (after receiving bad news or being in a severe argument), and the disorder has captured the public's imagination with names such as “broken heart syndrome.” The interest of the medical profession also has been piqued, with almost 400 hits in PubMed for a search of “Takotsubo AND 2009.” Differential heart rate dynamics in transient left ventricular apical and midventricular ballooningHeart RhythmVol. 7Issue 12PreviewThe aim of the present study was to assess potential differences in cardiac autonomic nervous modulation in patients with transient left ventricular apical ballooning syndrome (AB) and the midventricular variant (MB) of this syndrome. Full-Text PDF To the Editor—Takotsubo Cardiomyopathy: A Role for Magnesium?Heart RhythmVol. 7Issue 12PreviewI read with interest the original research article on the role of sympathoexcitation in Takotsubo cardiomyopathy by Raj.1 Both classic and inverted patterns of stress cardiomyopathy have been reported in association with disorders associated with catecholamine excess, including pheochromocytoma, high-dose epinephrine infusion, and Irukandji syndrome following jellyfish envenomation.2,3 Full-Text PDF