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Stress Cardiomyopathy: Emerging concepts on diagnosis and management

Samer Ellahham

 Stress cardiomyopathy, takotsubo cardiomyopathy, is a syndrome characterized by transient  regional  left  ventricular  dysfunction in the absence of significant coronary artery disease. Possible pathogenic mechanisms  include  catecholamine  excess, microvascular dysfunction, and  multivessel  coronary  artery  spasm.  The  diagnosis  should  be  suspected  in  adults  who present with a suspected acute coronary syndrome when the clinical manifestations are out of proportion to the degree          of elevation in cardiac biomarkers. A physical or emotional trigger is often but not always present. Wall  motion abnormalities     in patients with stress cardiomyopathy are typically the apical type, and atypical variants including mid-ventricular, basal,      focal, and global types. The differential diagnosis of stress cardiomyopathy  includes  acute  coronary  syndromes,  coronary  artery spasm, myocarditis, and pheochromocytoma. A high index of suspicion is key in the diagnosis and management.