Stress cardiomyopathy pathophysiology
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Unstable angina/non ST elevation myocardial infarction in Stress (Takotsubo) Cardiomyopathy |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Pathophysiology
The cause of stress cardiomyopathy is unknown. Several theories have been postulated to explain the pathophysiology behind it:
The etiology of stress cardiomyopathy appears to involve the response of the myocardium to a hyperadrenergic state. The syndrome is often preceded by significant emotional and physical stress. Serum catecholamines may be markedly elevated in patients with stress cardiomyopathy with levels greater than seen in patients with thrombotic ST elevation myocardial infarction or congestive heart failure, though this is not always present. Thus, it has been postulated that catecholamine excess contributes at least in part to the pathophysiology, and that catecholamines may cause direct myonecrosis.[1] It is thought that myocardial stunning seen in stress cardiomyopathy is largely mediated by the effects of epinephrine.[2]
- Multi-vessel epicardial coronary artery spasms:
This theory is not well accepted, as it has been noted that multi-vessel epicardial coronary artery vasospasm does not correlate with the areas of myocardium that are hypokinetic.
- Coronary microvascular impairment
Gross Pathology
Microscopic Pathology
Associated Conditions
Many neurological and psychiatric conditions are associated with the development of stress cardiomyopathy. These include:[3]
- Subarachnoid hemorrhage[4]
- Epilepsy[5]
- Electroconvulsive therapy[6]
- Head injury[7]
- Stroke[8]
- Anxiety and depression[9]
References
- ↑ Wittstein IS, Thiemann DR, Lima JA; et al. (2005). "Neurohumoral features of myocardial stunning due to sudden emotional stress". N. Engl. J. Med. 352 (6): 539–48. doi:10.1056/NEJMoa043046. PMID 15703419.
- ↑ Lyon AR, Rees PS, Prasad S, Poole-Wilson PA, Harding SE (2008). "Stress (Takotsubo) cardiomyopathy--a novel pathophysiological hypothesis to explain catecholamine-induced acute myocardial stunning". Nat Clin Pract Cardiovasc Med. 5 (1): 22–9. doi:10.1038/ncpcardio1066. PMID 18094670.
- ↑ Templin C, Ghadri JR, Diekmann J, Napp LC, Bataiosu DR, Jaguszewski M, Cammann VL, Sarcon A, Geyer V, Neumann CA, Seifert B, Hellermann J, Schwyzer M, Eisenhardt K, Jenewein J, Franke J, Katus HA, Burgdorf C, Schunkert H, Moeller C, Thiele H, Bauersachs J, Tschöpe C, Schultheiss HP, Laney CA, Rajan L, Michels G, Pfister R, Ukena C, Böhm M, Erbel R, Cuneo A, Kuck KH, Jacobshagen C, Hasenfuss G, Karakas M, Koenig W, Rottbauer W, Said SM, Braun-Dullaeus RC, Cuculi F, Banning A, Fischer TA, Vasankari T, Airaksinen KE, Fijalkowski M, Rynkiewicz A, Pawlak M, Opolski G, Dworakowski R, MacCarthy P, Kaiser C, Osswald S, Galiuto L, Crea F, Dichtl W, Franz WM, Empen K, Felix SB, Delmas C, Lairez O, Erne P, Bax JJ, Ford I, Ruschitzka F, Prasad A, Lüscher TF (2015). "Clinical Features and Outcomes of Takotsubo (Stress) Cardiomyopathy". N. Engl. J. Med. 373 (10): 929–38. doi:10.1056/NEJMoa1406761. PMID 26332547.
- ↑ Lee VH, Connolly HM, Fulgham JR, Manno EM, Brown RD, Wijdicks EF (2006). "Tako-tsubo cardiomyopathy in aneurysmal subarachnoid hemorrhage: an underappreciated ventricular dysfunction". J. Neurosurg. 105 (2): 264–70. doi:10.3171/jns.2006.105.2.264. PMID 17219832.
- ↑ Le Ven F, Pennec PY, Timsit S, Blanc JJ (2011). "Takotsubo syndrome associated with seizures: an underestimated cause of sudden death in epilepsy?". Int. J. Cardiol. 146 (3): 475–9. doi:10.1016/j.ijcard.2010.12.028. PMID 21194774.
- ↑ Sharp RP, Welch EB (2011). "Takotsubo cardiomyopathy as a complication of electroconvulsive therapy". Ann Pharmacother. 45 (12): 1559–65. doi:10.1345/aph.1Q393. PMID 22116995.
- ↑ Riera M, Llompart-Pou JA, Carrillo A, Blanco C (2010). "Head injury and inverted Takotsubo cardiomyopathy". J Trauma. 68 (1): E13–5. doi:10.1097/TA.0b013e3181469d5b. PMID 19065115.
- ↑ Yoshimura S, Toyoda K, Ohara T, Nagasawa H, Ohtani N, Kuwashiro T, Naritomi H, Minematsu K (2008). "Takotsubo cardiomyopathy in acute ischemic stroke". Ann. Neurol. 64 (5): 547–54. doi:10.1002/ana.21459. PMID 18688801.
- ↑ Summers MR, Lennon RJ, Prasad A (2010). "Pre-morbid psychiatric and cardiovascular diseases in apical ballooning syndrome (tako-tsubo/stress-induced cardiomyopathy): potential pre-disposing factors?". J. Am. Coll. Cardiol. 55 (7): 700–1. doi:10.1016/j.jacc.2009.10.031. PMID 20170799.