Psychiatric symptoms, personality profile and Takotsubo syndrome: clinical considerations

Takotsubo cardiomyopathy (TTC) is a recently described syndrome of heart failure and transient left ventricular dysfunction that is frequently precipitated by acute emotional or physical stress. Because patients with TTC typically present with chest pain, electrocardiographic abnormalities, elevated cardiac enzymes, and focal ventricular wall motion abnormalities, it is not surprising that they are often mistakenly diagnosed with acute myocardial infarction. As familiarity with TTC has increased, however, it has become clear that this syndrome not only has unique clinical features that can readily be distinguished from those of acute infarction, it also appears to have a distinct pathophysiology. In contrast to the irreversible myocardial injury seen with acute infarction, TTC is characterized by myocardial dysfunction that is transient and completely reversible and occurs in the absence of plaque rupture and coronary thrombosis. There is evidence that the myocardial stunning of TTC may be sympathetically mediated, but the precise pathogenesis of this disorder remains incompletely understood.