Author`s Reply.

To the Editor,

We all know that a unifying explanation about the mechanism of takotsubo cardiomyopathy (TTS) remains questionable, but the main explanation is the overstimulation of beta 1 receptors in the heart (no difference between myocardium and endocardium) due to catecholamine surge. This phenomenon leads to microcirculatory dysfunction and direct cardiotoxicity, which results in severe myocardial morphological alterations (1). The observed alterations occur as myocardial histological changes, including focal mononuclear inflammatory areas of fibrotic response and characteristic contraction bands.

Based on observations in our patient and the literature review, a phase of hypercontractility preceding the stage of regional wall motion abnormalities is noted in most patients.

Observations of reverse and mid-ventricular types of TTS in younger patients have raised questions about the underlying mechanisms for us too, but further studies and literature review are needed to clarify the exact explanation.