Am J Cardiovasc Dis 2013;3(1):53-59

Case Report
Takotsubo cardiomyopathy: reversible stress-induced cardiac insult - a
stress protective mechanism

Sachin Kumar Amruthlal Jain, Timothy R Larsen, Anas Souqiyyeh, Shukri W David

Providence Heart Institute, Providence Hospital and Medical Centers, MI, USA

Received October 16, 2012; Accepted December 11, 2012; Epub February 17, 2013; Published February 27, 2013

Abstract: Takotsubo cardiomyopathy (TCM) is characterized by a typical pattern of wall motion abnormalities (basal
hyperkinesis with mid-ventricular and apical hypokinesis) in the absence of obstructive coronary artery disease. The
clinical presentation often mimics acute coronary syndrome with anginal and anginal-equivalent symptoms, dynamic ECG
changes, and elevated cardiac biomarkers. Patients are predominantly postmenopausal women. In the vast majority of
cases an extremely stressful inciting event can be identified. The catecholamine surge occurring in response to stress has
been implicated as the trigger for this peculiar myocardial response. It appears the specific type of beta-adrenergic
receptor activation, relative epinephrine to norepinephrine activity, and a genetic predisposition all play a role. This
apparently paradoxical response to stress may, in fact, be an important evolutionary safety net preventing catecholamine
induced myocardial collapse. (AJCD1210003).

Keywords: Takotsubo cardiomyopathy, stress cardiomyopathy, adrenergic receptor polymorphism

Address correspondence to: Dr. Sachin Kumar Amruthlal Jain, Providence Heart Institute, Providence Hospital and
Medical Centers, 16001 West Nine Mile Road, Southfield, MI 48075. Phone: 248-849-2842; Fax: 248-849-2790; E-mail:
doctorsachin@gmail.com
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