Omerovic, Elmir, Citro, Rodolfo, Bossone, Eduardo, Redfors, Bjorn, Backs, Johannes, Bruns, Bastian, Ciccarelli, Michele, Couch, Liam S., Dawson, Dana, Grassi, Guido, Iacoviello, Massimo, Parodi, Guido, Schneider, Birke, Templin, Christian, Ghadri, Jelena R., Thum, Thomas, Chioncel, Ovidiu, Tocchetti, C. Gabriele, van der Velden, Jolanda, and Heymans, Stephane
This is the first part of a scientific statement from the Heart Failure Association (HFA) of the European Society of Cardiology focused upon the pathophysiology of Takotsubo syndrome and is complimentary to the previous HFA position statement on Takotsubo syndrome which focused upon clinical management. In part 1 we provide an overview of the pathophysiology of Takotsubo syndrome and fundamental questions to consider. We then review and discuss the central role of catecholamines and the sympathetic nervous system in the pathophysiology, and the direct effects of high surges in catecholamines upon myocardial biology including ß-adrenergic receptor signalling, G-protein coupled receptor kinases, cardiomyocyte calcium physiology, myofilament physiology, cardiomyocyte gene expression, myocardial electrophysiology and arrhythmogenicity, myocardial inflammation, metabolism and energetics. The integrated effects upon ventricular haemodynamics are discussed and integrated into the pathophysiological model. [ABSTRACT FROM AUTHOR]