eISSN: 1897-4295
ISSN: 1734-9338
Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej
Current issue Archive Manuscripts accepted About the journal Abstracting and indexing Subscription Contact Instructions for authors
SCImago Journal & Country Rank
vol. 14

Dying from Takotsubo syndrome at a young age: the crucial role of brain-heart interactions

Francesco Pelliccia, Andrea Moretti, Giuseppe Marazzi, Carlo Gaudio

Adv Interv Cardiol 2018; 14, 3 (53): 221–224
Online publish date: 2018/09/21
View full text
Get citation
JabRef, Mendeley
Papers, Reference Manager, RefWorks, Zotero
Takotsubo syndrome (TTS) is characterized by severe left ventricular dysfunction that typically recovers spontaneously within days or weeks [1]. TTS is typically described in association with sudden and severe emotional or physical stressors [2]. Symptoms, clinical signs, and echocardiographic and electrocardiographic findings in TTS patients are suggestive of an acute coronary syndrome [3]. At presentation, patients usually complain of chest pain and dyspnea, but TTS can also present as syncope and pulmonary edema. Cardiac arrest, cardiogenic shock, and serious ventricular arrhythmias occur more rarely in TTS patients. The most frequent finding on the admission electrocardiogram is ST-segment elevation, which most often is present in the precordial leads. Typically, TTS patients manifest modest increases in creatine kinase-MB and cardiac troponin concentrations as compared to myocardial infarction patients. Of interest, in TTS, there is a disparity between the degree of biomarker elevation and extent of myocardial dysfunction observed on left ventriculography. Diagnostic coronary angiography shows normal coronary arteries or non-obstructive coronary artery disease in the vast majority of patients [4]. Different patterns of LV dysfunction have been reported in TTS, including the classical apical variant, a mid-ventricular variant, a basal or inverted variant and regional variants. The prognosis of TTS was initially thought to be benign. Subsequent series, however, have demonstrated that both acute and long-term mortality are higher than previously recognized. Indeed, mortality reported during the acute phase in hospitalized patients is ~4–5%, a frequency comparable to that of ST-elevation myocardial infarction in the era of primary percutaneous coronary interventions. A recent meta-analysis of clinical correlates of acute mortality in TTS reported that the average in-hospital mortality is 4.5% [5]. Japanese investigators have recently pointed out that TTS is associated with an elevated in-hospital mortality due to co-existing chronic comorbidities and acute medical illnesses [6]. Of note, major adverse events, including cardiogenic shock, cardiac arrest and mortality, are more frequent in women than in men with TTS.
About 90% of patients with TTS are post-menopausal females with a similar prevalence across ethnic groups [7]. Conversely, the occurrence of TTS in the young is very uncommon. Recently, Urbinati et al. performed a systematic...

View full text...
Pelliccia F, Kaski JC, Crea F, et al. Pathophysiology of Takotsubo syndrome. Circulation 2017; 135: 2426-41.
Pelliccia F, Greco C, Vitale C, et al. Takotsubo syndrome (stress cardiomyopathy): an intriguing clinical condition in search of its identity. Am J Med 2014; 127: 699-704.
Ghadri JR, Wittstein IS, Prasad A, et al. International expert consensus document on Takotsubo syndrome (part I): clinical characteristics, diagnostic criteria, and pathophysiology. Eur Heart J 2018; 39: 2032-204.
Ghadri JR, Wittstein IS, Prasad A, et al. International expert consensus document on Takotsubo syndrome (part II): diagnostic workup, outcome, and management. Eur Heart J 2018; 39: 2047-62.
Singh K, Carson K, Shah R, et al. Meta-analysis of clinical correlates of acute mortality in Takotsubo cardiomyopathy. Am J Cardiol 2014; 113: 1420-8.
Isogai T, Yasunaga H, Matsui H, et al. Out-of-hospital versus in-hospital Takotsubo cardiomyopathy: analysis of 3719 patients in the diagnosis procedure combination database in Japan. Int J Cardiol 2014; 176: 413-7.
Templin C, Ghadri JR, Diekmann J, et al. Clinical features and outcomes of Takotsubo (stress) cardiomyopathy. N Engl J Med 2015; 373: 929-38.
Urbinati A, Pellicori P, Guerra F, et al. Takotsubo syndrome in the paediatric population: a case report and a systematic review. J Cardiovasc Med 2017; 18: 262-7.
Zalewska-Adamiec M, Bachórzewska-Gajewska H, Kralisz P, et al. Sudden cardiac arrest in the course of the Takotsubo syndrome in fifteen-year-old girl. Kardiol Interw 2018; 14: 318-9.
Pelliccia F, Parodi G, Greco C, et al. Comorbidities frequency in Takotsubo syndrome: an international collaborative systematic review including 1109 patients. Am J Med 2015; 128: 654.e11-9.
Y-Hassan S. Acute cardiac sympathetic disruption in the pathogenesis of the takotsubo syndrome: a systematic review of the literature to date. Cardiovasc Revasc Med 2014; 159: 35-42.
Crossman AR, Neary D. Neuroanatomy. 2nd edn. Churchill Livingston, London 2000.
Janig W. The Integrative Action of the Autonomic Nervous System. Cambridge University Press, Cambridge, UK 2006.
Vitale C, Rosano GM, Kaski JC. Role of coronary microvascular dysfunction in Takotsubo cardiomyopathy. Circ J 2016; 80: 299-305.
Crea F, Camici PG, Bairey Merz CN. Coronary microvascular dysfunction: an update. Eur Heart J 2014; 35: 1101-11.
Quick links
© 2019 Termedia Sp. z o.o. All rights reserved.
Developed by Bentus.
PayU - płatności internetowe