title: Takotsubo syndrome (stress cardiomyopathy): an intriguing clinical condition in search of its identity.
abstract: Takotsubo syndrome is a relatively frequent clinical entity presenting typically as an acute coronary syndrome in the absence of obstructive coronary artery disease and characterized angiographically by transient left ventricular systolic dysfunction, sparing the basal segments of the left ventricle ("apical ballooning"). Takotsubo syndrome characteristically affects peri- or postmenopausal women, albeit recent series show that men also are at risk. Takotsubo syndrome is characteristically triggered by severe emotional or physical stress, which suggests a pathogenic role for increased sympathetic activity leading to myocardial perfusion abnormalities and ventricular dysfunction. The reasons why severe emotional and physical stress result in the development of takotsubo syndrome in certain individuals but not others is still a matter of speculation, but strongly suggests the existence of predisposing factors/mechanisms in certain subjects. The present article reviews the different factors that can play a role in the development of takotsubo syndrome in different patients. We propose that triggers (ie, emotional stressors, physical stressors, iatrogenic stressors, and neurologic triggers), pathogenic mechanisms (ie, increased catecholamine levels, coronary vasomotor abnormalities leading to myocardial ischemia), and predisposing factors (ie, cardiovascular risk factors, endothelial dysfunction, comorbidities) all interact in a complex fashion and possibly differently in different patients to cause takotsubo syndrome. Identifying these factors may help in preventing and managing the condition more effectively.
authors.affiliation: Department 'Attilio Reale', Sapienza University, Rome, Italy. Electronic address: f.pelliccia@mclink.it.
authors.forename: Francesco
authors.initials: F
authors.lastname: Pelliccia
authors.affiliation: Department 'Attilio Reale', Sapienza University, Rome, Italy.
authors.forename: Cesare
authors.initials: C
authors.lastname: Greco
authors.affiliation: IRCCS San Raffaele Pisana, Rome, Italy; Cardiovascular and Cell Sciences Research Institute, St. George's, University of London, London, UK.
authors.forename: Cristiana
authors.initials: C
authors.lastname: Vitale
authors.affiliation: IRCCS San Raffaele Pisana, Rome, Italy; Cardiovascular and Cell Sciences Research Institute, St. George's, University of London, London, UK.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Rosano
authors.affiliation: Department 'Attilio Reale', Sapienza University, Rome, Italy; Eleonora Lorillard Spencer Cenci Foundation, Rome, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Gaudio
authors.affiliation: Cardiovascular and Cell Sciences Research Institute, St. George's, University of London, London, UK.
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Kaski
mesh_terms: D006801:Humans; D013312:Stress, Physiological; D013315:Stress, Psychological / Q000150:complications*; D054549:Takotsubo Cardiomyopathy / Q000209:etiology* / Q000473:pathology* / Q000523:psychology
keywords: Cardiomyopathy; Ischemic heart disease; Personalized treatment; Takotsubo