title: Current hypotheses regarding the pathophysiology behind the takotsubo syndrome.
abstract: Takotsubo syndrome is an increasingly recognized acute cardiac affliction which is characterized by severe regional left ventricular dysfunction that cannot be explained by one or more occlusive culprit lesions of a coronary artery. A preceding somatic and/or emotional stressor can be identified in a majority of these patients and older women are overrepresented among the afflicted. Catecholamine levels are elevated in patients with takotsubo and exogenous catecholamine administration may cause or exacerbate the condition. Hence, catecholamines appear implicated in the pathogenesis. However, beyond catecholamine the pathogenesis of the takotsubo syndrome is unclear. Five distinct hypotheses have been postulated which attempt to explain why specific regions within the left ventricle are affected in takotsubo. In this manuscript we critically review these hypotheses in light of the available data. We discuss how the different hypotheses may be complementary to each other and to which extent they are contradicting one another.
authors.affiliation: Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden. Electronic address: bjorn.redfors@wlab.gu.se.
authors.forename: Björn
authors.initials: B
authors.lastname: Redfors
authors.affiliation: Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Yangzhen
authors.initials: Y
authors.lastname: Shao
authors.affiliation: Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Anwar
authors.initials: A
authors.lastname: Ali
authors.affiliation: Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Elmir
authors.initials: E
authors.lastname: Omerovic
mesh_terms: D002395:Catecholamines / Q000097:blood; D005260:Female; D006801:Humans; D008297:Male; D012737:Sex Factors; D013315:Stress, Psychological / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology*; D054549:Takotsubo Cardiomyopathy / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology*; D018487:Ventricular Dysfunction, Left / Q000097:blood / Q000175:diagnosis / Q000503:physiopathology
chemical_list: D002395:Catecholamines
keywords: Takotsubo syndrome; β-Adrenoceptor