Anxiodepressive Disorders and Chronic Psychological Stress Are Associated With Tako-Tsubo Cardiomyopathy

Delmas, Clément; Lairez, Olivier; Mulin, Emmanuel; Delmas, Thomas; Boudou, Nicolas; Dumonteil, Nicolas; Biendel-Picquet, Caroline; Roncalli, Jérôme; Elbaz, Meyer; Galinier, Michel; Carrié, Didier

doi:10.1253/circj.cj-12-0759

Cited by 64 publications

(56 citation statements)

References 42 publications

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“…Several studies have also reported a higher frequency of comorbid psychiatric disorders such as anxiety, depression and substance abuse. 28- 30 However, these are not universally present and hence not useful in making the diagnosis.…”

Section: Demographicsmentioning

confidence: 99%

Diagnosis of Takotsubo Cardiomyopathy

Scantlebury

Prasad

2014

Circ J

243

208

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Section: Demographicsmentioning

confidence: 99%

Diagnosis of Takotsubo Cardiomyopathy

Scantlebury

Prasad

2014

Circ J

243

208

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“…In a retrospective casecontrol study, Summers and colleagues 87 demonstrated that 68% of patients with TS had either anxiety or depression, and the prevalence of these disorders was higher than in patients with myocardial infarction or in healthy controls. 87 In one of the few prospective trials examining psychological disorders in TS, Delmas and colleagues 88 found the incidence of depression and anxiety to be as high as 78%, which was significantly higher than in patients with acute coronary syndromes. Depressed patients have an exaggerated norepinephrine response to emotional stress, 89 and a subset of patients with major depressive disorders have increased spillover and decreased reuptake of norepinephrine.…”

Section: Mood Disorders/anxietymentioning

confidence: 99%

The Sympathetic Nervous System in the Pathogenesis of Takotsubo Syndrome

Wittstein

2016

Heart Failure Clinics

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“…Indeed, interesting observations have been reported by the psychiatry community regarding the prevalence of anxiodepressive symptoms among those afflicted by TTS. 29 It is rare to directly observe the acute effects, and only occurs when medical monitoring is already present. Considering 2 cases of TTS with different etiologies (epinephrine and cocaine (Moffett's solution) application to the nasopharynx and anesthesia induction with subsequent intubation), sinus tachycardia, hypertension with a pronounced pulse pressure (as high as 227/121 mmHg) and ST-segment elevation 30, 31 were present in both.…”

Section: Ultra-acute Clinical Phase (0-1 Hour)mentioning

confidence: 99%

Pathophysiology of Takotsubo Syndrome

Wright

Tranter

Morley-Smith

et al. 2014

Circ J

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Takotsubo syndrome (TTS), also known as takotsubo cardiomyopathy, stress cardiomyopathy and apical ballooning syndrome, is an acute, reversible heart failure (HF) syndrome that has increasingly come to medical attention over the past 24 years with wider access to early diagnostic coronary angiography for patients with acute chest pain and ECG abnormalities. 1 The typical case is a postmenopausal woman with an extremely stressful emotional or physical trigger, who presents with chest pain and breathlessness, ECG changes and acute hypokinesia of the apical and middle segments of the left ventricle (LV) in a circumferential pattern extending beyond a single coronary territory, and in the absence of culprit obstructive coronary artery disease (CAD). 2,3 Providing the patient survives the acute event, the dysfunctional segments recover, at least macroscopically, within days to weeks. 4 Many other variations on this "typical case" exist, including different demographics (men, younger women), different anatomical variants (basal/inverted, mid-LV, biventricular), spontaneous cases without a triggering stressor, cases triggered by other medical, surgical or psychiatric emergencies and permanent cardiac abnormalities (permanent "new" left bundle branch block, apical transmural necrosis).One common feature appears to be an extreme surge in catecholamines in response to the triggering stress or coexisting medical condition (eg, subarachnoid hemorrhage, pheochromocytoma, and thyrotoxicosis). 5-7 Animal models can replicate the features of this HF syndrome in order to dissect its mechanisms. 8-11 In contrast to the reductionist approach in most modern pathophysiological research, the more that is understood about TTS, the more it is apparent that a number of processes may result in the final common pathway of acute apical dysfunction. There are a number of mediators that may modify the severity and course of a particular episode. Defining the precise pathophysiology is challenging, and we suggest that an integrated approach to studying the cardiovascular responses to extreme surges in catecholamines is appropriate.Here we use a novel approach to reviewing the pathophysiology of TTS. Animal and clinical studies have reported findings at different phases through the development of this condition, and it is intuitive that the observed integrated cardiovascular responses to surges in serum catecholamines and sympathetic neural outflow would change over time. We discuss the pathophysiology in a sequential fashion describing effects as they occur at different time-points, integrating the observations and explaining the negative inotropic response and potential activation of cardioprotective mechanisms.Before discussing the temporal sequence of events, it is important to note a growing body of evidence that TTS is not a form of acute myocardial infarction (MI). Firstly, the epide- Takotsubo syndrome (TTS), also known as takotsubo cardiomyopathy, is an acute heart failure syndrome that typically occurs after a period of great emotion...

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Anxiodepressive Disorders and Chronic Psychological Stress Are Associated With Tako-Tsubo Cardiomyopathy

Cited by 64 publications

References 42 publications

Diagnosis of Takotsubo Cardiomyopathy

Diagnosis of Takotsubo Cardiomyopathy

The Sympathetic Nervous System in the Pathogenesis of Takotsubo Syndrome

Pathophysiology of Takotsubo Syndrome

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