Tako-tsubo cardiomyopathy: clinical presentation and underlying mechanism

Since Dr Sato at Hiroshima City Hospital first recognized and reported the concept of tako-tsubo cardiomyopathy in 1990, this disorder has become accepted worldwide as a distinct clinical entity. Tako-tsubo cardiomyopathy is an important disorder as a differential diagnosis of acute myocardial infarction. This disorder usually occurs in postmenopausal women of an advanced age, and is characterized by transient left ventricular apical wall motion abnormalities associated with emotional or physical stress. Typically, left ventricular apical wall motion abnormalities are transient and resolve during a period of days to weeks. The prognosis is generally favorable. However, several acute complications have been reported such as congestive heart failure, cardiac rupture, hypotension, left ventricular apical thrombosis, or Torsade de Pointes. Several possible mechanisms such as multivessel coronary artery spasm, coronary microvascular dysfunction, myocarditis, or catecholamine toxicity have been proposed to explain tako-tsubo cardiomyopathy, but its pathophysiology is not well understood.