Takotsubo cardiomyopathy: pathophysiology and treatment.

Since it was first described 20 years ago in Japan, takotsubo cardiomyopathy has received considerable interest from the medical community around the world, particularly in recent years. Although takotsubo cardiomyopathy was originally described as a transient, stress-induced dysfunction of the left ventricular apex, other morphological subtypes have now been described. The pathogenesis of this disorder is likely to be catecholamine mediated myocyte damage and microvascular dysfunction; however, a number of possible alternative theories have been suggested. These include oxidative stress, transient coronary obstruction and oestrogen deficiency, the last explaining the high prevalence of takotsubo cardiomyopathy in women. The treatment remains largely supportive; however, a number of agents have been implicated in the acute stage and long term. Although most of the patients show complete recovery, there is a high risk of complications at the initial presentation requiring intense support.