Takotsubo cardiomyopathy is an unusual response of the left ventricle to extreme emotional stress .The catecholamine surge has a profound stunning effect of LV apex and a paradoxical hypercontractility of basal LV.
The exact mechanism is not clear , Following factors may contribute.
- Multi-vessel coronary artery spasm,
- Cardiac microvascular dysfunction.
- Abnormal myocardial fatty acid metabolism,
- Reperfusion injury after an ACS *
However , the most accepted mechanism is Endogenous catecholamine-induced myocardial stunning and microinfarction
Why is LV apex alone affected ?
The adrenergic receptor distribution is high in LV apex .They are exposed to high concentration and gets stunned easily . Basal LV has less adrenergic innervation , so it shows less of catecholamine toxicity , instead it exhibits. hyper-contractile mode. However, this rule is not absolute.
One more suggestion was apical balloons correlated with wrap around LAD.(Báñez B et all 2004)
Reference from this site
1.Báñez B, Navarro F, Farré J et al. (2004). Tako-tsubo syndrome associated with a long course of the left anterior descending coronary artery along the apical diaphragmatic surface of the left ventricle.]”. Revista española de cardiología (in Spanish; Castilian) 57 (3): 209–16
2.Carrillo A, Fiol M, Garcia-Niebla J, Bayes de Luna A. Electrocardiographic differential diagnosis between Takotsubo syndrome and distal occlusion of LAD is not easy. J Am Coll Cardiol. Nov 2 2010;56(19
4.Kosuge M, Ebina T, Hibi K, Morita S, Okuda J, Iwahashi N. Simple and accurate electrocardiographic criteria to differentiate takotsubo cardiomyopathy from anterior acute myocardial infarction. J Am Coll Cardiol. 2010;55(22):2514–6. doi: 10.1016/j.jacc.2009.12.059.