Stress Cardiomyopathy

Abstract

Recently, an increasing number of cases of stress cardiomyopathy, mainly occurring in elderly women, have been documented in many parts of the world. In Japan, this disease is known as takotsubo cardiomyopathy (named after the fishing pot used for trapping octopus). Symptoms of this condition are akin to those of acute myocardial infarction, but no obstructive lesions are found in the coronary arteries, and left ventricular apical ballooning is present. Stress cardiomyopathy is now a well-recognized cause of acute heart failure, lethal ventricular arrhythmias, and ventricular rupture. Although the precise mechanism of onset of this condition is still controversial, two major pathogenic mechanisms have been proposed: catecholamine cardiotoxicity and neurogenic stunned myocardium. We summarize the findings of studies conducted to date on stress cardiomyopathy-from bench to bedside and bedside to bench.

Takotsubo cardiomyopathy has a unique cardiac biomarker profile: NT-proBNP/myoglobin and NT-proBNP/troponin T ratios for the differential diagnosis of acute coronary syndromes and stress induced cardiomyopathy

“…[16] In contrast, markers of myocardial damage -like troponin, CK, CK-MB and myoglobin -will especially be elevated in the setting of membrane leakage caused by myocardial necrosis, whereas TC is characterized by reversible myocardial damage without necrosis. [17][18][19] Therefore, the typical constellation of TC is characterized by a steep increase of NT-proBNP due to the compromised left ventricular function in the presence of only slightly elevated markers of myocardial necrosis.…”

Estimation of Risk Factors for Cardiogenic Shock in Takotsubo Cardiomyopathy: A Retrospective Study

“…The pathogenesis of Takotsubo cardiomyopathy remains elusive but the suggested mechanisms include widespread coronary vasospasms, catecholamine or neurogenic stunning of myocardium as a result of sympathetic overstimulation from intense and sudden stress, impairment of microvascular perfusion or less likely transient myocarditis (10,11). In the present study an attempt was made to improve our understanding about TCM through identification of factors that may precede or coincide with cardiogenic shock presentation, allowing us to use the information in clinical practice for risk stratification and anticipation of possible catastrophic change in patient's clinical course.…”

Stress-induced cardiomyopathy in a primary reference hospital: prevalence and clinical presentation

“…The pathogenesis of TC is not completely understood, but several arguments plead in favour of a hyperactivity of the sympathetic system to which women are more prone than men and that is responsible for cellular and vascular toxicity [7,14]. Formerly, the catecholamine-induced myocardial toxicity was known under the entity "stunned myocardium" in cases of intracranial haemorrhages or paroxysms of pheochromocytoma [15][16][17][18].…”

“…Formerly, the catecholamine-induced myocardial toxicity was known under the entity "stunned myocardium" in cases of intracranial haemorrhages or paroxysms of pheochromocytoma [15][16][17][18]. Indeed, many studies demonstrated a dysfunction of the sympathetic system located at the apical level using I123-MIBG myocardial scintigraphy [14,19], an increase of plasma catecholamines levels Cardiovascular Medicine 2010;13(11):326-333 20] has been excluded by endomyocardial biopsies [16,[22][23][24], cardiac magnetic resonance imaging [23,28] and negative viral serologies [19,[22][23].…”