title: Psychosocial and psychoneuroendocrinal aspects of Takotsubo syndrome.
abstract: Great advances have been made in our understanding of Takotsubo syndrome in the past decade, but the aetiology of the condition remains incompletely understood. The most established theory, that catecholamine-mediated myocardial stunning is provoked by emotional or physiological stress, is supported by the presence of supraphysiological levels of plasma catecholamines in patients with Takotsubo syndrome. For this reason, the hyperexcitability of the autonomic nervous system under conditions of physical and emotional stress is often assessed in these patients. Observational studies have indicated that a predisposing influence of chronic or traumatic stress, anxiodepressive disorders, and maladaptive personality traits are linked to the pathogenesis of Takotsubo syndrome. Chronic stress can influence autonomic function through dysregulation of the hypothalamic-pituitary-adrenal axis and contribute to the development of cardiovascular disorders. In this Perspectives article, we discuss the current knowledge of the psychoneuroendocrinological and psychosocial mechanisms underlying the pathophysiology of Takotsubo syndrome.
authors.affiliation: Institute of General Practice, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany; the Department of Neurology, Heart &Brain Research Group, University Hospital Giessen and Marburg, Klinikstrasse 33, 35392 Giessen, Germany; and at the Department of Heart Surgery, Kerckhoff Heart and Thorax Center, Benekestrasse 2-8, 61231 Bad Nauheim, Germany.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Kastaun
authors.affiliation: Department of Neurology, Heart &Brain Research Group, University Hospital Giessen and Marburg, Klinikstrasse 33, 35392 Giessen, Germany; and at the Department of Neurology, Gesundheitszentrum Wetterau, Chaumontplatz 1, 61231 Bad Nauheim, Germany.
authors.forename: Tibo
authors.initials: T
authors.lastname: Gerriets
authors.affiliation: Department of Neurology, Heart &Brain Research Group, University Hospital Giessen and Marburg, Klinikstrasse 33, 35392 Giessen, Germany.
authors.forename: Marlene
authors.initials: M
authors.lastname: Tschernatsch
authors.affiliation: Department of Neurology, Heart &Brain Research Group, University Hospital Giessen and Marburg, Klinikstrasse 33, 35392 Giessen, Germany.
authors.forename: Mesut
authors.initials: M
authors.lastname: Yeniguen
authors.affiliation: Department of Neurology, Heart &Brain Research Group, University Hospital Giessen and Marburg, Klinikstrasse 33, 35392 Giessen, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Juenemann
mesh_terms: D000223:Adaptation, Psychological; D001007:Anxiety / Q000503:physiopathology; D003863:Depression / Q000503:physiopathology; D006339:Heart Rate; D006801:Humans; D006854:Hydrocortisone / Q000097:blood / Q000502:physiology; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology; D010551:Personality; D010913:Pituitary-Adrenal System / Q000503:physiopathology; D013315:Stress, Psychological / Q000503:physiopathology; D054549:Takotsubo Cardiomyopathy / Q000175:diagnosis / Q000503:physiopathology* / Q000523:psychology*
chemical_list: D006854:Hydrocortisone