Takotsubo Cardiomyopathy: Understanding the Pathophysiology of Selective Left Ventricular Involvement

Deepak Kumar Pasupula; Venkata Suresh Patthipati; Awais Javed; Sudeep K Siddappa Malleshappa

doi:10.7759/cureus.5972

Takotsubo Cardiomyopathy: Understanding the Pathophysiology of Selective Left Ventricular Involvement

Cureus. 2019 Oct 23;11(10):e5972. doi: 10.7759/cureus.5972.

Authors

Deepak Kumar Pasupula¹, Venkata Suresh Patthipati², Awais Javed¹, Sudeep K Siddappa Malleshappa³

Affiliations

¹ Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, USA.
² Internal Medicine, Trumbull Regional Medical Center, Warren, USA.
³ Internal Medicine, Baystate Medical Center, Springfield, USA.

Abstract

Takotsubo cardiomyopathy (TCM) has gained global recognition as a unique cardiovascular disease that mimics acute myocardial infarction. Since its initial description, more than three decades ago, we have significantly advanced our understanding of diagnosing, treating, and prognosticating this reversible cardiovascular phenomenon. However, the pathophysiological explanation behind its selective involvement of the left ventricle (LV), predominantly the LV apex in poorly understood. In this brief review on differential distribution of the adrenergic nerve (AN) and cholinergic nerve (CN) in the normal human heart, we try to extrapolate an idea of poor CN distribution in the LV apex as an associated factor augmenting microcirculatory dysfunction due to an unopposed AN activity from the catecholamine surge, as a plausible explanation for this characteristic phenomenon.

Keywords: adrenergic receptors; cholinergic receptors; coronary microcirculation; pathophysiology; takotsubo cardiomyopathy.

Publication types

Review