Microvascular Dysfunction in Takotsubo Cardiomyopathy

Takotsubo cardiomyopathy or stress-induced cardiomyopathy, is characterized by transient cardiac dysfunction, usually but not always triggered by physical or emotional stress. Takotsubo cardiomyopathy may mimic an acute coronary syndrome due to an overlapping presenting clinical spectrum. Typically, apical involvement with hypercontraction of basal left ventricle (apical type) is predominant, but atypical types involving basal, midventricular, and right ventricular myocardium have also been described. To date, the exact pathogenic mechanism of this disease remains unclear, however, sympathetic or catecholaminergic hyperactivity, mutivessel coronary vasospasm, microcirculatory disorder, and estrogen deficiency have been proposed to be the likely underlying pathogenic mechanisms. In this review, we specifically highlight the association of microcirculatory dysfunction in takotsubo cardiomyopathy which has been more recently recognized as an important pathogenetic contributor to this disease.