Abstract
Takotsubo cardiomyopathy (TTC), a persistently obscure dysfunctional condition of the left ventricle, is uniquely transient but nevertheless dangerous. It features variable ventricular patterns and is predominant in women. For 30 years, pathophysiologic investigations have progressed only slowly and with inadequate focus. It was initially proposed that sudden-onset spastic obliteration of coronary flow induced myocardial ischemia with residual stunning and thus TTC. Later, it was generally accepted without proof that, in the presence of pain or emotional stress, the dominant mechanism for TTC onset was a catecholamine surge that had a direct, toxic myocardial effect. We think that the manifestations of TTC are more dynamic and complex than can be assumed from catecholamine effects alone. In addition, after reviewing the recent medical literature and considering our own clinical observations, especially on spasm, we theorize that atherosclerotic coronary artery disease modulates and physically opposes obstruction during spasm. This phenomenon may explain the midventricular variant of TTC and the lower incidence of TTC in men. We continue to recommend and perform acetylcholine testing to reproduce TTC and to confirm our theory that coronary spasm is its initial pathophysiologic factor. An improved understanding of TTC is especially important because of the condition’s markedly increased incidence during the ongoing COVID-19 pandemic.
Keywords: Acetylcholine; catecholamines/metabolism; coronary artery disease/complications; coronary vasospasm/complications/physiopathology; plaque, atherosclerotic/physiopathology; risk factors; sex differences; takotsubo cardiomyopathy/blood/etiology/physiopathology; ventricular function, left/drug effects.
【저자키워드】 Risk factors, sex differences, Acetylcholine, catecholamines/metabolism, coronary artery disease/complications, coronary vasospasm/complications/physiopathology, plaque, atherosclerotic/physiopathology, takotsubo cardiomyopathy/blood/etiology/physiopathology, ventricular function, left/drug effects., 【초록키워드】 Risk factors, Stress, COVID-19 pandemic, variant, Sex, risk, metabolism, Coronary artery disease, Takotsubo cardiomyopathy, Pain, Manifestations, women, incidence, mechanism, clinical observations, Acetylcholine, manifestation, Coronary artery, emotional, Myocardial ischemia, emotional stress, left ventricle, atherosclerotic, complex, catecholamine, proof, plaque, obstruction, dominant, Effect, men, Effects, Myocardial, feature, initial, coronary spasm, spasm, spastic, physically, addition, modulate, predominant, explain, assumed, pathophysiologic, progressed, ventricular, 【제목키워드】 debate,