The case for takotsubo cardiomyopathy (syndrome) as a variant of acute myocardial infarction

Abstract

In consideration of our critical analysis of a substantial body of evidence, we propose that takotsubo cardiomyopathy (syndrome) conforms closely to a variant of AMI characterized by acute transmural ischemia interrupted by spontaneous reperfusion, resulting in a unique condition for which dominant features are postischemic myocardial stunning and irreversible injury (necrosis). Evidence for acute myocardial ischemia includes typical presenting symptoms together with ischemic electrocardiographic changes, transmural myocardial edema, and regional wall motion abnormality. The presence of myocardial necrosis is supported by dynamic troponin release together with histopathology demonstrating contraction bands and other findings of cell death. Reperfusion and stunning are manifest by reversible regional LV wall motion abnormality and dynamic T-wave inversion with QT interval lengthening. Defining the mechanism responsible for myocardial ischemia and necrosis in takotsubo cardiomyopathy (syndrome) may lead to a better understanding of the pathophysiology of these events and ultimately to more effective management for this increasingly common condition.