Mechanisms of stress (Takotsubo) cardiomyopathy

Nef, Holger; Möllmann, Helge; Akashi, Yoshihiro J.; Hamm, Christian W.

doi:10.1038/nrcardio.2010.16

Cited by 233 publications

(202 citation statements)

References 65 publications

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“…Several hypotheses have been presented to explain this unique cardiac disorder in TTC (15)(16)(17)(18)(19) and broadly divided into a vascular or myocardial cause. These may not be mutually exclusive because the entire cardiovascular system is exposed to the same catecholamine storm.…”

Section: Introductionmentioning

confidence: 99%

Role of echocardiography for takotsubo cardiomyopathy: clinical and prognostic implications

Izumo¹,

Akashi²

2018

Cardiovasc. Diagn. Ther.

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Takotsubo cardiomyopathy (TTC) is newly-described secondary cardiomyopathy characterized by transient left ventricular (LV) dysfunction, which is increasingly recognized in the field of cardiology.TTC occurs in approximately 2% of the patients with acute coronary syndrome. Its onset is rare; however, its specific features play a crucial role in diagnosing the chest pain in clinical practice. TTC has generally favorable outcome with rapid recovery of LV function; however, an increasing evidence suggests that it should be regarded as a more serious acute cardiac disorder with a variety of complications. Owing to its widespread availability, even in emergency settings, transthoracic echocardiography plays a key role in the diagnostic assessment of TTC and contributes to an increased number of disease detection and incidence reports in contemporary clinical practice. This review focuses on the role of echocardiography in understanding the clinical prognostic implications in patients with TTC.

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Section: Introductionmentioning

confidence: 99%

Role of echocardiography for takotsubo cardiomyopathy: clinical and prognostic implications

Izumo¹,

Akashi²

2018

Cardiovasc. Diagn. Ther.

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“…Once this area is affected there is loss of sympathetic inhibition leading to catecholamine surge in the body which can lead to myocytolysis [14]. This subsequent catecholamine surge may also induce LV dysfunction with LV apical ballooning [2][3][4]. Imaging showed that patient with raised troponin have stroke that more commonly involved the right posterior, superior, and medial insula and the right inferior parietal lobe exerting loss of inhibition of sympathetic pathway by insular cortex [13].…”

Section: Discussionmentioning

confidence: 99%

“…Literature search demonstrated that Electrocardiographic (ECG) changes might be seen with acute stroke. Various mechanisms have been set forth to validate the relation between acute stroke and troponin elevation with ECG changes which are imputed to the increase in catecholamine, which in turn, lead to myocyte injury [2][3][4] . Elevated troponin is seen after stroke and is associated with increased mortality [5].…”

Section: Introductionmentioning

confidence: 99%

Cardiac electrical and biochemical abnormalities in acute stroke: A case report

Bakhsh¹,

Alkhawam²,

Zaiem³

et al. 2015

IJCRI

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International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties.Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations. We report a case of 87-year-old female presented with cough, lethargy, decreased oral intake, shortness of breath, chest pain and altered mental status. Head computed tomography (CT) scan did not reveal any acute intracranial pathology. Laboratory work showed cardiac troponin T elevation with ECG changes were concerning for cardiac ischemia. Careful examination was significant for right facial droop and right sided weakness. A repeat head CT scan showed acute stroke. IJCRI publishes Conclusion:Patient with ischemic stroke may have shown to have an association with elevated cTnT. They are at an increased risk of mortality from renal and/or cardiac failure. Though ECG changes and cTnT levels can be attributed to stroke, given the common risk factors shared by coronary artery disease and stroke, a cardiac work up is warranted to rule out any acute myocardial event or look up for the source of stroke which most likely to be cardiac.

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“…We believe that catecholamine surge is an important condition for initial energy failure and could explain some pathological findings such as contraction band necrosis and interstitial edema (4). As long as the balance between energy demand and supply is maintained, catecholamine alone cannot account for the development of TCM.…”

Section: Catecholamine Cardiotoxicitymentioning

confidence: 99%

“…Many papers have reported enhanced catecholamine levels in TCM patients (3,4). We believe that catecholamine surge is an important condition for initial energy failure and could explain some pathological findings such as contraction band necrosis and interstitial edema (4).…”

Section: Catecholamine Cardiotoxicitymentioning

confidence: 99%

Energy Failure Hypothesis for Takotsubo Cardiomyopathy

Hirano

Shimizu

Ikeda

et al. 2017

Annals of Nuclear Cardiology

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Takotsubo cardiomyopathy (TCM) is a transient myocardial stunning, typically showing apical ballooning. Although catecholamine toxicity, vasospasm, and disturbed microcirculation have been implicated, the precise pathophysiology of TCM is unknown. We present a two-step energy failure hypothesis which could explain the clinical course and pathogenesis. Sudden stress-induced increase in cardiac energy demand of normal subjects can be compensated for by additional supply of long chain fatty acids released from triglycerides stored in adipose tissues. Subjects at high risk for TCM cannot tolerate such stress-induced energy demand/supply imbalance, which triggers initial energy failure and induces myocytes' stunning in vulnerable mid-and apical myocardial segments. Receptor-mediated uptake for energy substrates then declines due to impairment of contraction-dependent recruitment of responsible transporters (e. g. CD36). This in turn induces the second energy failure, which prolongs the myocardial stunning. Eventually, spontaneous or therapeutic improvements in the energetics awaken the heart.

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Mechanisms of stress (Takotsubo) cardiomyopathy

Cited by 233 publications

References 65 publications

Role of echocardiography for takotsubo cardiomyopathy: clinical and prognostic implications

Role of echocardiography for takotsubo cardiomyopathy: clinical and prognostic implications

Cardiac electrical and biochemical abnormalities in acute stroke: A case report

Energy Failure Hypothesis for Takotsubo Cardiomyopathy

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