Stress-induced cardiomyopathy (Takotsubo) – broken heart and mind?

Figures & data

Figure 1 Midventricular variant of stress-induced cardiomyopathy. End-diastolic (A) and end-systolic (B) images of the left ventricle, obtained during ventriculography, in a patient with chest pain.

Note: Basal and apical function is preserved, whereas the midventricular regions are clearly akinetic.

Table 1 Preceding somatic or emotional stressors in the development of stress-induced cardiomyopathy

Somatic stressors	Emotional stressors
Vigorous exercise	Grief (eg, death or illness of a loved one)
Pheochromocytoma	Receiving bad news (eg, being diagnosed with major illness, learning of a daughter’s divorce)
Subarachnoid hemorrhage	Fear
Seizure	Relationship conflicts
Postoperative pain	Public speaking
Hyperthyroidism	Financial problems
Alcohol/opiate withdrawal	Being bullied
Invasive medical procedures	Surprise party
Exacerbation of underlying noncardiac disease	Changing residence
	Involvement in accident
Sexual intercourse
Administration of sympathomimetics

Table 2 Myoclinic criteria and Gothenburg criteria in the diagnosis of stress-induced cardiomyopathy

Mayo clinic criteria^Citation3,Citation42	Gothenburg criteria^Citation14
Transient hypokinesis, akinesis, or dyskinesis in the left ventricular midsegments, with or without apical involvement; regional wall motion abnormalities that extend beyond a single epicardial vascular distribution; and frequently, but not always, a stressful trigger	Transient hypokinesis, akinesis, or dyskinesis in the left-ventricular segments and frequently, but not always, a stressful trigger (psychical or physical)
The absence of obstructive coronary disease or angiographic evidence of acute plaque rupture	The absence of other pathological conditions (eg, ischemia, myocarditis, toxic damage, tachycardia, etc) that may more credibly explain the regional dysfunction
New electrocardiogram (ECG) abnormalities (ST-segment elevation and/or T-wave inversion) or modest elevation in cardiac troponin	No elevation or modest elevation in cardiac troponin (ie, disparity between the troponin level and the amount of the dysfunctional myocardium present)
The absence of pheochromocytoma and myocarditis	Normal or near normal filling pressure

Figure 2 Connection between stress-induced cardiomyopathy (SIC) and neuropsychiatry.

Notes: A somatic and/or emotional stressor can be identified in most SIC patients. Although these stressors are often categorized as either emotional or somatic, they could also be viewed as elements of a continuous spectrum of stressors able to induce SIC.

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