From Basic Cardiac Imaging to Image Fusion by Paolo Marzullo & Giuliano Mariani

Author:Paolo Marzullo & Giuliano Mariani
Language: eng
Format: epub
Publisher: Springer Milan, Milano

4.1.5.6 In Stress Cardiomyopathy

Takotsubo syndrome is a clinical entity characterized by acute but rapidly reversible LV systolic dysfunction, with midventricular-wall-motion abnormalities, apical akinesia or dyskinesia, and preserved or hyperkinetic contractile function of the basal LV segments in the absence of atherosclerotic coronary artery disease (CAD) triggered by acute emotional or physical stress. Several hypotheses are advocated as possible pathophysiologic mechanisms, including catecholamine-mediated multivessel epicardial spasm, microvascular coronary spasm, and direct catecholamine-mediated myocyte toxicity. However, it remains unclear whether these abnormalities are the primary cause of the disorder or secondary events. As the entity is much more common in postmenopausal women, important influences of sex hormones on the sympathetic neurohormonal axis and on coronary vasoreactivity have been suggested. [123I]-MIBG imaging shows reduced uptake in the akinetic LV apex, with normal or only mildly reduced perfusion within this region [28].

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