Stress-induced cardiomyopathy in the ICU

Stress-induced cardiomyopathy (siCM), also known as Takotsubo syndrome, is an acute, transient, and typically reversible form of myocardial dysfunction. In the intensive care unit (ICU), siCM remains underrecognized because its clinical presentation, electrocardiographic abnormalities, and biomarker profile often overlap with acute coronary syndromes and other critical illness-associated cardiomyopathies. Unlike the emotional triggers commonly described in ambulatory populations, ICU-associated siCM is more frequently precipitated by severe physiologic stressors, including sepsis, neurologic injury, respiratory failure, major surgery, and exposure to vasoactive therapies. The pathophysiology of siCM is multifactorial and incompletely understood but appears largely driven by excessive sympathetic activation and catecholamine-mediated myocardial injury. Additional contributory mechanisms include coronary microvascular dysfunction, myocardial metabolic stress, neurocardiac axis dysregulation, and inflammatory signaling. Individual susceptibility factors, including postmenopausal estrogen deficiency and genetic variation in adrenergic pathways, may further increase vulnerability. Early recognition and ICU-specific diagnostic strategies are essential to improve management and outcomes in critically ill patients.