Review
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Jul 26, 2016; 8(7): 413-424
Published online Jul 26, 2016. doi: 10.4330/wjc.v8.i7.413
Takotsubo syndrome: Advances in the understanding and management of an enigmatic stress cardiomyopathy
Hernán David Mejía-Rentería, Iván J Núñez-Gil
Hernán David Mejía-Rentería, Servicio de Cardiología, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, 28805 Madrid, Spain
Hernán David Mejía-Rentería, Iván J Núñez-Gil, Instituto Cardiovascular, Hospital Universitario Clinico San Carlos, 28040 Madrid, Spain
Author contributions: Both authors contributed to this manuscript.
Conflict-of-interest statement: The authors state that there is no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Iván J Núñez-Gil, MD, PhD, Instituto Cardiovascular, Hospital Universitario Clínico San Carlos, C/Profesor Martín Lagos, S/N, 28040 Madrid, Spain. ibnsky@yahoo.es
Telephone: +34-91-3303000 Fax: +34-91-3303182
Received: March 26, 2016
Peer-review started: March 27, 2016
First decision: April 15, 2016
Revised: April 30, 2016
Accepted: May 17, 2016
Article in press: May 27, 2016
Published online: July 26, 2016
Processing time: 113 Days and 20.7 Hours
Abstract

Takotsubo cardiomyopathy is a syndrome mimicking an acute myocardial infarction in absence of obstructive epicardial coronary artery disease to explain the degree of the wall motion abnormalities. Typically more common in the elderly women, this condition is usually triggered by unexpected emotional or physical stress situations, and is associated with electrocardiogram abnormalities and slight elevation of cardiac biomarkers. The pathophysiological mechanism is not clear yet, but it is believed that a high circulating concentration of catecholamines causes an acute dysfunction of the coronary microcirculation and metabolism of cardiomyocytes, leading to a transient myocardial stunning. Typically, it presents with acute left ventricular systolic dysfunction that in most cases is completely resolved at short term. Recurrences are rare and it is thought that the long-term prognosis is good. We present here a review of the clinical features, pathophysiology and management of this enigmatic condition.

Keywords: Takotsubo cardiomyopathy; Stress; Review; Myocardial stunning; Left ventricle systolic dysfunction

Core tip: Takotsubo cardiomyopathy is a syndrome mimicking an acute myocardial infarction in absence of obstructive epicardial coronary artery disease to explain the degree of the wall motion abnormalities. Typically more common in the elderly women, this condition is usually triggered by unexpected emotional or physical stress situations, and presents with acute left ventricular systolic dysfunction that in most cases is completely resolved at short term. Recurrences are rare and it is thought that the long-term prognosis is good. We present here a review of the clinical features, pathophysiology and management of this enigmatic condition.