Table of Contents
ISRN Cardiology
Volume 2012, Article ID 593735, 6 pages
Review Article

Insights into the Pathogenesis of Takotsubo Syndrome, Which with Persuasive Reasons Should Be Regarded as an Acute Cardiac Sympathetic Disease Entity

Department of Cardiology, Karolinska Institute, Karolinska University Hospital, Huddinge, 141 86 Stockholm, Sweden

Received 24 August 2012; Accepted 19 September 2012

Academic Editors: Y. Furukawa, S. Gielen, and R. Sicari

Copyright © 2012 Shams Y-Hassan. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


The pathogenesis of takotsubo syndrome (TS) has not been established yet. The literature data dealing with the pathogenesis of TS are abundant but scattered among different medical specialities. Subarachnoid hemorrhage and other acute intracranial diseases and injuries are among the important and currently well-recognized trigger factors for TS. In both induced and spontaneous subarachnoid hemorrhages, signs suggestive of increased cardiac sympathetic overactivity have been documented. Surgical and pharmacological sympathectomy has shown to have protective cardiac effects in both animal and human studies. Increase in local release of norepinephrine from the heart of patients with TS has been measured. Signs of both cardiac sympathetic denervation and myocardial lesions adjacent to the cardiac nerve terminals have been seen. Furthermore, the systematized and typically circumferential pattern of ventricular wall motion abnormality is incongruent with the coronary artery supply region and appears most likely to follow the cardiac sympathetic nerve distribution. In conclusion, compelling literature data support the hypothesis that acute cardiac sympathetic disruption and norepinephrine seethe and spillover is causing TS in predisposed patients. TS is most probably an acute cardiac sympathetic disease entity causing myocardial stunning in which takotsubo is one among other cardiac image study findings.