Stress cardiomyopathy (takotsubo cardiomyopathy)

Due to the rise in the number of reports of stress cardiomyopathy in the literature, awareness of this condition is increasing. Although different names have been used to describe this condition, the similarities in clinical, electrocardiographic, echocardiographic, and angiographic features suggest that they represent the same spectrum of diseases with different underlying causes. The pathophysiology of stress cardiomyopathy remains controversial.

We describe a series of four cases of stress cardiomyopathy admitted to our institution over a period of six months with different presentations, but similar clinical course, EKG, echocardiographic, and catheterization findings. The ages ranged from 22 to 81 years; all four females. All showed characteristic wall motion abnormalities by imaging in the absence of significant coronary artery disease, with spontaneous recovery of left ventricular function with conservative therapy.

Although the patients presented with different clinical scenarios, all four showed characteristic features of stress cardiomyopathy suggesting that the pathophysiology affecting the myocardium was the same. We present a review of the literature with a discussion of the history of this condition, characteristic clinical features, and diagnostic criteria used in the past as well as the suggested pathophysiology of this condition.

Stress cardiomyopathy is an underdiagnosed reversible cardiomyopathy triggered by severe emotional or physical stress. It represents a spectrum of conditions with reversible severe left ventricular systolic dysfunction that includes neurogenic cardiomyopathy. It is not confined to the Japanese population and can affect people of any ethnic background or nationality.