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World J Cardiol. Jul 26, 2014; 6(7): 602-609
Published online Jul 26, 2014. doi: 10.4330/wjc.v6.i7.602
Takotsubo cardiomyopathy: Pathophysiology, diagnosis and treatment
Kazuo Komamura, Miho Fukui, Toshihiro Iwasaku, Shinichi Hirotani, Tohru Masuyama
Kazuo Komamura, Miho Fukui, Toshihiro Iwasaku, Shinichi Hirotani, Tohru Masuyama, Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya 663-8501, Japan
Author contributions: Komamura K designed and wrote the paper; Fukui M and Iwasaku T acquired clinical data; Hirotani S criticized intellectual content; Masuyama T finally approved the paper.
Correspondence to: Kazuo Komamura, MD, PhD, Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya 663-8501, Japan. komamura@hyo-med.ac.jp
Telephone: +81-798-456553 Fax: +81-798-456551
Received: December 27, 2013
Revised: February 22, 2014
Accepted: May 31, 2014
Published online: July 26, 2014
Processing time: 236 Days and 6.5 Hours
Abstract

In 1990, takotsubo cardiomyopathy (TCM) was first discovered and reported by a Japanese cardiovascular specialist. Since then, this heart disease has gained worldwide acceptance as an independent disease entity. TCM is an important entity that differs from acute myocardial infarction. It occurs more often in postmenopausal elderly women, is characterized by a transient hypokinesis of the left ventricular (LV) apex, and is associated with emotional or physical stress. Wall motion abnormality of the LV apex is generally transient and resolves within a few days to several weeks. Its prognosis is generally good. However, there are some reports of serious TCM complications, including hypotension, heart failure, ventricular rupture, thrombosis involving the LV apex, and torsade de pointes. It has been suggested that coronary spasm, coronary microvascular dysfunction, catecholamine toxicity and myocarditis might contribute to the pathogenesis of TCM. However, its pathophysiology is not clearly understood.

Keywords: Cardiomyopathy; Catecholamine; Heart failure; Myocardial Infarction; Stress

Core tip: Takotsubo cardiomyopathy (TCM) is an important disease entity that differs from acute myocardial infarction. It occurs more often in postmenopausal elderly women, is characterized by a transient hypokinesis of the left ventricular (LV) apex, and is associated with emotional or physical stress. Wall motion abnormality of the LV apex is generally transient and resolves within a few days to several weeks. The prognosis of TCM is generally good. It has been suggested that coronary spasm, coronary microvascular dysfunction, catecholamine toxicity and myocarditis might contribute to the pathogenesis of TCM. However, its pathophysiology is not clearly understood.