Mechanisms of stress (Takotsubo) cardiomyopathy

Nat Rev Cardiol. 2010 Apr;7(4):187-93. doi: 10.1038/nrcardio.2010.16. Epub 2010 Mar 2.


Stress cardiomyopathy, also referred to as Takotsubo cardiomyopathy, transient apical ballooning or broken heart syndrome, is a disorder associated with transient left ventricular dysfunction. Symptoms include acute chest pain and dyspnea accompanied by electrocardiographic changes, such as ST-segment elevation and T-wave inversions, minimal elevation of cardiac enzyme levels and transient wall-motion abnormalities in the absence of substantial coronary artery obstruction. Complete recovery of contractile function has been documented in nearly all cases, but the mechanisms of disease remain unclear and the cause has not been established. Coronary artery vasospasm, microcirculation dysfunction, and transient obstruction of the left ventricular outflow tract have been proposed as possible causes of this disorder. An excessive release of catecholamines also seems to have a pivotal role in the development of stress cardiomyopathy. This Review summarizes published data on stress cardiomyopathy, focusing primarily on the most likely causes of this cardiac entity.

Publication types

  • Review

MeSH terms

  • Acute Disease
  • Animals
  • Catecholamines / blood
  • Coronary Vasospasm / complications
  • Disease Models, Animal
  • Humans
  • Microcirculation
  • Prevalence
  • Risk Factors
  • Sarcoplasmic Reticulum Calcium-Transporting ATPases / metabolism
  • Stress, Psychological / complications*
  • Stress, Psychological / physiopathology
  • Sympathetic Nervous System / physiopathology
  • Takotsubo Cardiomyopathy / epidemiology
  • Takotsubo Cardiomyopathy / etiology*
  • Takotsubo Cardiomyopathy / physiopathology*
  • United States / epidemiology
  • Ventricular Dysfunction, Left
  • Ventricular Outflow Obstruction / complications


  • Catecholamines
  • Sarcoplasmic Reticulum Calcium-Transporting ATPases
  • ATP2A2 protein, human