Takotsubo syndrome.

The Takotsubo Syndrome was first described by Japanese investigators approximately 20 years ago and has been increasingly recognized in all countries. It occurs almost exclusively in postmenopausal women and is triggered by a severe emotional stress. Severe chest pain is common and the electrocardiogram often mimics that seen with an acute myocardial infarction. An echocardiogram or a left ventriculogram resembles a Takotsubo, a Japanese octopus fishing pot. In Japanese 'Takotsubo' means a 'fishing pot for trapping octopus.' These traps have a round bottom with a narrow neck. When the octopus enters the Takotsubo it is most often trapped while the fisherman pulls the device to the surface. The syndrome is reversible and over the next several weeks to months all electrocardiographic and echocardiographic changes revert to normal. It is likely that the emotionally induced catecholamine surge in an estrogen-deficient woman causes a combination of epicardial coronary artery constriction, constriction of the myocardial microvasculature, and direct cardiomyocyte toxicity producing a temporary stunning effect on the left ventricular myocardium.