Pathophysiology of Takotsubo Syndrome.

Transient left ventricular (LV) apical ballooning syndrome, Takotsubo cardiomyopathy, Takotsubo syndrome (TTS), broken heart syndrome, ampulla cardiomyopathy, or stress-induced cardiomyopathy are interchangeable terms and have all been applied to define a syndrome characterized by transient left ventricular systolic and diastolic dysfunction, electrocardiographic features and myocardial enzyme elevation similar to the acute myocardial infarction but in the absence of obstructive epicardial coronary artery disease. First described in Japan in the 1990s, the syndrome has gained worldwide attention within the scientific community in the past few decades. The disease manifests predominantly in postmenopausal females in the presence of stressful triggers such as severe physical or emotional stress, natural disasters such as earthquakes, unexpected death of relatives, acute medical illnesses, etc. Initially thought to be a benign condition, recent reports have demonstrated that TTS may be associated with severe complications and mortality similar to acute coronary syndrome. Concerted efforts have been made to define various pathophysiologic aspects of TTS; however, the precise etiologic understanding remains unclear. Some of the mechanisms proposed for the development of Takotsubo syndrome include elevated levels of circulating plasma catecholamines and their metabolites, microvascular dysfunction, inflammation, estrogen deficiency, spasm of the epicardial coronary vessels, and aborted myocardial infarction. Herein, we define each mechanism in further detail. The typical patient will present with chest pain, ECG showing ST-segment elevation, and increased troponin. However, when patients undergo cardiac catheterization, the left ventricle has apical ballooning and no evidence of coronary artery disease. The shape of the left ventricle during systole appears like an 'octopus pot. The modified Mayo Clinic criteria are used to make the diagnosis of Takotsubo cardiomyopathy and include the following: 1. Absence of coronary artery disease on angiography. 2. Transient dyskinesis, hypokinesis, or akinesis of the left ventricle midsegments with or without apical involvement. 3. ECG evidence of ST-segment elevation and/or T wave inversion. 4. Modest elevation of troponin levels. 5. Absence of myocarditis or pheochromocytoma. The exact number of people with the disorder remains unknown because not all patients undergo angiography following chest pain. The majority of patients are Asians or Whites and present with symptoms in the 6th decade of life. Close to 90% of cases have been reported in postmenopausal females. Copyright © 2024, StatPearls Publishing LLC.

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