"Broken heart syndrome": catecholamine surge or aborted myocardial infarction?
Takotsubo cardiomyopathy, also called transient left ventricular apical ballooning or "broken heart syndrome", is a cardiac condition that mimics the clinical presentation of acute coronary syndrome but without any evidence of obstructive atherosclerotic coronary artery disease. An episode of intense emotional or physiologic stress, serving as the nidus for a catecholamine surge, has been reported prior to presentation and is presumed to be the triggering factor playing the pathogenic role. We report a unique case of Takotsubo cardiomyopathy without any known precipitating factors. After reviewing multiple case reports and review articles, the evidence supporting a "catecholamine surge" is empirically plausible; however, our case calls this theory into question. The "aborted MI" hypothesis is more convincing as an all-inclusive nidus for the pathogenesis and clinical presentation described in Takotsubo syndrome. More detailed studies and research are needed to ascertain the pathogenesis and optimal management of this syndrome.
Khallafi
Hicham
H
Department of Cardiology, Easton Hospital, Easton, PA, 18042, USA. khalhich@yahoo.com
Chacko
Vinod
V
Varveralis
Nickolas
N
Elmi
Farhad
F
D006328:Cardiac Catheterization; D002395:Catecholamines / Q000378:metabolism*; D002637:Chest Pain / Q000175:diagnosis / Q000209:etiology; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000175:diagnosis / Q000628:therapy; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination; D017548:Echocardiography, Transesophageal; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008133:Long QT Syndrome / Q000175:diagnosis; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis*; D018570:Risk Assessment; D054549:Takotsubo Cardiomyopathy / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis*
D002395:Catecholamines