Association of prolonged QTc interval with Takotsubo cardiomyopathy: A neurocardiac syndrome inside the mystery of the insula of Reil

Abstract

The Takotsubo cardiomyopathy is often considered autochthonous to the heart, although the primary problem may be not in the heart muscle itself. Instead, similar to several Takotsubo-like cardiac pathologies seen in acute neurological diseases, it may reflect the capacity of the nervous system to injure the heart. Persuasive evidence exists that shocking emotional stress promotes direct heart injuries. Moreover, clinical and laboratory research shows that cardiac structural damage can occur in the presence of a normal heart, especially in the context of seizures, stroke, and traumatic brain injury or under conditions of psychological stress. The aim of this review is to summarize the clinical implications of these observations, several of which focus on the pivotal role of the insula of Reil in the brain-heart connection, to unravel the mystery of Takotsubo cardiomyopathy pathogenesis.

Response to Association of Prolonged QTc Interval With Takotsubo Cardiomyopathy: A Neurocardiac Syndrome Inside the Mystery of the Insula of Reil

“…We would like to thank John Madias, MD for his interest in our review about the mystery of the pathogenesis of Takotsubo cardiomyopathy (TC) . We agree with his semantic restraint of the eponym Wellens electrocardiographic pattern, which needs a contextual disambiguation.…”

“…Regarding the hypothesized mechanism for myocardial ischemia (coronary microvascular spasm and dysfunction) in TC, as discussed in our review, some inconsistencies exist: (1) Apical and midventricular wall motion abnormalities do not match the distribution of epicardial coronary arteries, but are, however, congruent with cardiac nerve distribution illustrated by Antonio Scarpa. (2) The histopathological changes termed myocytolysis do not resemble those seen in myocardial ischemia, and appear most likely to be associated with direct cardiomyocyte toxicity of endogenous catecholamines, released into the heart via nerve terminals.…”

Insular cortex lesions are not the only culprit in Takotsubo syndrome

“…With interest we read the considerations of Marafioti et al about the association of Takotsubo syndrome (TTS) and the insular cortex (insula of Reil) . We have the following comments and concerns.…”

QTc interval in takotsubo cardiomyopathy: How the activation of insular cortex interacts

“…We read the interesting review article by Marafioti et al, who reported on the association of prolonged QTc interval with takotsubo cardiomyopathy (Tc) in relation to right insular cortex (Ic) activity. Several points should be taken into account when interpreting the theory presented by Marafioti et al…”

“…Thus, the anterior portion of the right Ic might have a strong association with SNS activity. In the article by Marafioti et al, although the relationship between right Ic and SNS was suggested, there was no description about the relationship between Ic and QTc interval in relation to anterior vs posterior Ic of the left hemisphere.…”