title: Epidemiology and pathophysiology of Takotsubo syndrome.
abstract: Takotsubo syndrome is an acute cardiac syndrome first described in 1990 and characterized by transient left ventricular dysfunction affecting more than one coronary artery territory, often in a circumferential apical, mid-ventricular, or basal distribution. Several pathophysiological explanations have been proposed for this syndrome and its intriguing appearance, and awareness is growing that these explanations might not be mutually exclusive. The reversible apical myocardial dysfunction observed might result from more than one pathophysiological phenomenon. The pathophysiology of Takotsubo syndrome is complex and integrates neuroendocrine physiology, potentially involving the cognitive centres of the brain, and including the hypothalamic-pituitary-adrenal axis. Cardiovascular responses are caused by the sudden sympathetic activation and surge in concentrations of circulating catecholamines. The multiple morphological changes seen in the myocardium match those seen after catecholamine-induced cardiotoxicity. The acute prognosis and recurrence rate are now known to be worse than initially thought, and much still needs to be learned about the epidemiology and the underlying pathophysiology of this fascinating condition in order to improve diagnostic and treatment pathways.
authors: Division of Cardiology, Department of Internal Medicine, St Marianna University School of Medicine, 2-16-1 Sugao Miyamae-ku, Kawasaki City, Kanagawa 216-8511, Japan.
authors: Yoshihiro J
authors: YJ
authors: Akashi
authors: Medizinische Klinik I, Kardiologie und Angiologie, Universitätsklinikum Gießen, Rudolf-Buchheim-Straße 8, Gießen 35392, Germany.
authors: Holger M
authors: HM
authors: Nef
authors: NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College, Sydney Street, London SW3 6NP, UK.
authors: Alexander R
authors: AR
authors: Lyon
mesh_terms: D002395:Catecholamines / Q000502:physiology; D006801:Humans; D009206:Myocardium / Q000473:pathology; D011379:Prognosis; D013315:Stress, Psychological / Q000150:complications / Q000503:physiopathology; D054549:Takotsubo Cardiomyopathy / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology
chemical_list: D002395:Catecholamines