This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Bybee, K. A. Articles by Prasad, A. Search for Related Content PubMed Articles by Bybee, K. A. Articles by Prasad, A. Related Collections Myocardial cardiomyopathy disease Acute coronary syndromes

(Circulation. 2008;118:397-409.)
© 2008 American Heart Association, Inc.

Contemporary Reviews in Cardiovascular Medicine

Stress-Related Cardiomyopathy Syndromes

Kevin A. Bybee, MD; Abhiram Prasad, MD, FRCP, FESC

From the Department of Medicine, University of Missouri–Kansas City, and Cardiovascular Consultants, PA, and St. Luke’s Mid America Heart Institute, Kansas City, Mo (K.A.B.); and Department of Medicine, Mayo Clinic College of Medicine, Cardiac Catheterization Laboratory, and Division of Cardiovascular Diseases and Department of Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minn (A.P.).

Correspondence to Kevin A. Bybee, MD, Cardiovascular Consultants, PA, 20 NW Saint Luke’s Blvd, Suite 240, Lee’s Summit, MO 64081. E-mail kbybee@cc-pc.com

Key Words: cardiovascular diseases • heart failure • myocardium • takotsubo cardiomyopathy

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
The relationship between the heart and the brain is complex and integral in the maintenance of normal cardiovascular function. Certain pathological conditions can interfere with the normal brain-heart regulatory mechanisms and result in impaired cardiovascular function. The mechanisms through which the central and autonomic nervous systems regulate the heart and the manner in which their impairment adversely affects cardiovascular function have recently been reviewed by Samuels.¹ The purpose of this article is to provide an up-to-date review of the clinical presentation of the stress-related cardiomyopathy syndromes, discuss possible causal mechanisms, and highlight the similarities and differences between them.^2–16

The stress-related cardiomyopathies appear similar in that they seemingly occur during times of enhanced sympathetic tone and may be precipitated in part or entirely by excessive endogenous or exogenous catecholamine stimulation of the myocardium. Although significant clinical overlap exists in those presenting with stress-associated cardiomyopathy, it is unclear whether myocardial adrenergic hyperstimulation is the only pathophysiological mechanism responsible for these syndromes (Tables 1 and 2).

View this table:   Table 1. Precipitants of Stress Cardiomyopathy

View this table:   Table 2. Morphological LV Variants of Stress Cardiomyopathy

	Transient Left Ventricular Dysfunction After Acute Emotional or Physical Stress (Takotsubo Cardiomyopathy, Apical Ballooning Syndrome)

 
In the early 1990s, Japanese authors began reporting a unique, reversible cardiomyopathy that appeared to be precipitated by acute emotional stress.^2,13,16 They found that these patients were usually postmenopausal women and often developed signs and symptoms of an acute coronary syndrome (ACS) proximate to a strong emotional stressor associated with a transient apical and midventricular wall motion abnormality despite the lack of obstructive coronary artery disease (CAD) at the time of . . . [Full Text of this Article]

This article has been cited by other articles:

				T. T. Tsai, B. K. Nallamothu, A. Prasad, S. Saint, and E. R. Bates A Change of Heart N. Engl. J. Med., September 3, 2009; 361(10): 1010 - 1016. [Full Text] [PDF]

				E. Omerovic Did Jesus die of a 'broken heart'? Eur J Heart Fail, August 1, 2009; 11(8): 729 - 731. [Full Text] [PDF]

				A. Latib, A. Ielasi, M. Montorfano, and A. Colombo Broken heart syndrome: tako-tsubo cardiomyopathy Can. Med. Assoc. J., May 12, 2009; 180(10): 1033 - 1034. [Full Text] [PDF]

				A. K Ghosh, E. Hatfield, and S. Connolly Catecholamine-induced transient myocardial dysfunction BMJ Case Reports, May 12, 2009; 2009(may12_1): bcr1220081349 - bcr1220081349. [Abstract] [Full Text]

				R. Margey, P. Diamond, H. McCann, and D. Sugrue Dobutamine stress echo-induced apical ballooning (Takotsubo) syndrome Eur J Echocardiogr, May 1, 2009; 10(3): 395 - 399. [Abstract] [Full Text] [PDF]

				S. S. Pedersen, N. Kupper, and J. Denollet CHAPTER 35 Psychological Factors and Heart Disease ESC Textbook of Cardiovascular Medicine, January 1, 2009; 2(1): med-9780199566990-chapter - med-9780199566990-chapter. [Abstract] [Full Text] [PDF]

				C. Hasdemir, O. Yavuzgil, E. Simsek, C. Ulucan, and C. S. Cinar Stress cardiomyopathy (Tako-Tsubo) following radiofrequency ablation in the right ventricular outflow tract Europace, December 1, 2008; 10(12): 1452 - 1454. [Abstract] [Full Text] [PDF]

				J. Farre and B. Ibanez Danger to the ventricular myocardium from prolonged ablation procedures combined with a long-lasting catecholamine infusion for provocative arrhythmia testing Europace, December 1, 2008; 10(12): 1361 - 1362. [Full Text] [PDF]