Skip to main content

Advertisement

Log in

Autonomic nervous system in Takotsubo syndrome

  • Published:
Heart Failure Reviews Aims and scope Submit manuscript

Abstract

Takotsubo syndrome (TTS) is an acute and usually reversible heart failure syndrome with symptoms resembling acute myocardial infarction, however, without obstruction of coronary arteries. In the majority of cases, TTS is preceded by emotional or physical stress and the disease concerns mainly postmenopausal women. Although several hypotheses have been introduced, the pathogenesis of TTS is controversial and still remains to be determined. As reported in recent studies, the role of the autonomic nervous system (ANS) seems to be pivotal in the pathogenesis of TTS. Therefore, the aim of this article is to summarize and discuss the current knowledge of the pathogenesis of TTS with a special focus on the ANS.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Lyon AR, Bossone E, Schneider B, Sechtem U, Citro R, Underwood SR, Sheppard MN, Figtree GA, Parodi G, Akashi YJ, Ruschitzka F, Filippatos G, Mebazaa A, Omerovic E (2016) Current state of knowledge on Takotsubo syndrome: a position statement from the taskforce on Takotsubo syndrome of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 18(1):8–27. https://doi.org/10.1002/ejhf.424

    Article  PubMed  Google Scholar 

  2. Y-Hassan S, De Palma R (2017) Contemporary review on the pathogenesis of Takotsubo syndrome: the heart shedding tears: Norepinephrine churn and foam at the cardiac sympathetic nerve terminals. Int J Cardiol 228:528–536. https://doi.org/10.1016/j.ijcard.2016.11.086

    Article  PubMed  Google Scholar 

  3. Deshmukh A, Kumar G, Pant S, Rihal C, Murugiah K, Mehta JL (2012) Prevalence of Takotsubo cardiomyopathy in the United States. Am Heart J 164(1):66–71 e61. https://doi.org/10.1016/j.ahj.2012.03.020

    Article  PubMed  Google Scholar 

  4. Brinjikji W, El-Sayed AM, Salka S (2012) In-hospital mortality among patients with Takotsubo cardiomyopathy: a study of the National Inpatient Sample 2008 to 2009. Am Heart J 164(2):215–221. https://doi.org/10.1016/j.ahj.2012.04.010

    Article  PubMed  Google Scholar 

  5. Sato HTH, Umemura T, Dote K, Ishihara M (1990) Tako-tsubo-like left ventricular dysfunction due to multivessel coronary spasm. In: Kodama K, Haze K, Hori M (eds) Clinical aspect of myocardial injury: from ischemia to heart failure. Kagakuhyoronsha Publishing Co, Tokyo, Japan, pp 56–64

    Google Scholar 

  6. Dote K, Sato H, Tateishi H, Uchida T, Ishihara M (1991) Myocardial stunning due to simultaneous multivessel coronary spasms: a review of 5 cases. J Cardiol 21(2):203–214

    CAS  PubMed  Google Scholar 

  7. Komamura K, Fukui M, Iwasaku T, Hirotani S, Masuyama T (2014) Takotsubo cardiomyopathy: pathophysiology, diagnosis and treatment. World J Cardiol 6(7):602–609. https://doi.org/10.4330/wjc.v6.i7.602

    Article  PubMed  PubMed Central  Google Scholar 

  8. Sharkey SW, Lesser JR, Maron MS, Maron BJ (2011) Why not just call it tako-tsubo cardiomyopathy. J Am Coll Cardiol 57(13):1496–1497

    Article  PubMed  Google Scholar 

  9. Haghi D, Athanasiadis A, Papavassiliu T, Suselbeck T, Fluechter S, Mahrholdt H, Borggrefe M, Sechtem U (2006) Right ventricular involvement in Takotsubo cardiomyopathy. Eur Heart J 27(20):2433–2439

    Article  PubMed  Google Scholar 

  10. Kurisu S, Inoue I, Kawagoe T, Ishihara M, Shimatani Y, Mitsuba N, Hata T, Nakama Y, Kisaka T, Kijima Y (2005) Takotsubo-like transient biventricular dysfunction with pressure gradients. Intern Med 44(7):727–732

    Article  PubMed  Google Scholar 

  11. Novak G, Kross K, Follmer K, Brofferio A, Shirani J (2007) Transient biventricular apical ballooning: a unique presentation of the “broken heart”. Clin Cardiol 30(7):355–358

    Article  PubMed  PubMed Central  Google Scholar 

  12. Abdulla I, Kay S, Mussap C, Nelson G, Rasmussen H, Hansen P, Ward M (2006) Apical sparing in tako-tsubo cardiomyopathy. Intern Med J 36(7):414–418

    Article  CAS  PubMed  Google Scholar 

  13. Schneider B, Sechtem U (2016) Influence of age and gender in Takotsubo syndrome. Heart Fail Clin 12(4):521–530

    Article  PubMed  Google Scholar 

  14. Templin C, Ghadri JR, Diekmann J, Napp LC, Bataiosu DR, Jaguszewski M, Cammann VL, Sarcon A, Geyer V, Neumann CA, Seifert B, Hellermann J, Schwyzer M, Eisenhardt K, Jenewein J, Franke J, Katus HA, Burgdorf C, Schunkert H, Moeller C, Thiele H, Bauersachs J, Tschope C, Schultheiss HP, Laney CA, Rajan L, Michels G, Pfister R, Ukena C, Bohm M, Erbel R, Cuneo A, Kuck KH, Jacobshagen C, Hasenfuss G, Karakas M, Koenig W, Rottbauer W, Said SM, Braun-Dullaeus RC, Cuculi F, Banning A, Fischer TA, Vasankari T, Airaksinen KE, Fijalkowski M, Rynkiewicz A, Pawlak M, Opolski G, Dworakowski R, MacCarthy P, Kaiser C, Osswald S, Galiuto L, Crea F, Dichtl W, Franz WM, Empen K, Felix SB, Delmas C, Lairez O, Erne P, Bax JJ, Ford I, Ruschitzka F, Prasad A, Luscher TF (2015) Clinical features and outcomes of Takotsubo (stress) cardiomyopathy. N Engl J Med 373(10):929–938. https://doi.org/10.1056/NEJMoa1406761

    Article  CAS  PubMed  Google Scholar 

  15. Ghadri JR, Sarcon A, Diekmann J, Bataiosu DR, Cammann VL, Jurisic S, Napp LC, Jaguszewski M, Scherff F, Brugger P, Jancke L, Seifert B, Bax JJ, Ruschitzka F, Luscher TF, Templin C, Inter TAKC-i (2016) Happy heart syndrome: role of positive emotional stress in takotsubo syndrome. Eur Heart J 37(37):2823–2829. https://doi.org/10.1093/eurheartj/ehv757

    Article  PubMed  PubMed Central  Google Scholar 

  16. Wittstein IS (2016) The sympathetic nervous system in the pathogenesis of Takotsubo syndrome. Heart Fail Clin 12(4):485–498

    Article  PubMed  Google Scholar 

  17. Wittstein IS (2012) Stress cardiomyopathy: a syndrome of catecholamine-mediated myocardial stunning? Cell Mol Neurobiol 32(5):847–857. https://doi.org/10.1007/s10571-012-9804-8

    Article  CAS  PubMed  Google Scholar 

  18. Nef HM, Mollmann H, Kostin S, Troidl C, Voss S, Weber M, Dill T, Rolf A, Brandt R, Hamm CW, Elsasser A (2007) Tako-Tsubo cardiomyopathy: intraindividual structural analysis in the acute phase and after functional recovery. Eur Heart J 28(20):2456–2464. https://doi.org/10.1093/eurheartj/ehl570

    Article  PubMed  Google Scholar 

  19. Aoki Y, Kodera S, Watanabe T, Miyauchi Y, Kanda J, Ooe K (2016) Autopsy findings in takotsubo cardiomyopathy with special reference to the autonomic nervous system. Int J Cardiol 203:236–237

    Article  PubMed  Google Scholar 

  20. Shams Y (2016) Clinical features and outcome of epinephrine-induced takotsubo syndrome: analysis of 33 published cases. Cardiovasc Revasc Med 17(7):450–455

    Article  Google Scholar 

  21. Elikowski W, Małek-Elikowska M, Karoń J, Mrozińska M, Baszko A, Horbacka K (2017) Takotsubo cardiomyopathy after intravenous epinephrine administration following cardiac arrest provoked by pneumoperitoneum-a case report. Polski merkuriusz lekarski: organ Polskiego Towarzystwa Lekarskiego 42(250):165–169

    Google Scholar 

  22. Nassif J, Nahouli H, Khali A, Mikhael E, Gharzeddine W, Ghaziri G (2017) Epinephrine-induced Takotsubo cardiomyopathy during laparoscopic myomectomy: case report and review of the literature. J Minim Invasive Gynecol 24:1037–1039

    Article  PubMed  Google Scholar 

  23. Kajander OA, Virtanen MP, Sclarovsky S, Nikus KC (2013) Iatrogenic inverted takotsubo syndrome following intravenous adrenaline injections for an allergic reaction. Int J Cardiol 165(1):e3–e5

    Article  PubMed  Google Scholar 

  24. Collen J, Bimson W, Devine P (2008) A variant of Takotsubo cardiomyopathy: a rare complication in the electrophysiology lab. J Invasive Cardiol 20(11):E310–E313

    PubMed  Google Scholar 

  25. Winogradow J, Geppert G, Reinhard W, Resch M, Radke P, Hengstenberg C (2011) Tako-tsubo cardiomyopathy after administration of intravenous epinephrine during an anaphylactic reaction. Int J Cardiol 147(2):309–311

    Article  CAS  PubMed  Google Scholar 

  26. Ghanim D, Adler Z, Qarawani D, Kusniec F, Amir O, Carasso S (2015) Takotsubo cardiomyopathy caused by epinephrine-treated bee sting anaphylaxis: a case report. J Med Case Rep 9(1):247

    Article  PubMed  PubMed Central  Google Scholar 

  27. Kido K, Guglin M (2017) Drug-induced Takotsubo cardiomyopathy. J Cardiovasc Pharmacol Ther 1074248417708618

  28. Redfors B, Ali A, Shao Y, Lundgren J, Gan L-M, Omerovic E (2014) Different catecholamines induce different patterns of takotsubo-like cardiac dysfunction in an apparently afterload dependent manner. Int J Cardiol 174(2):330–336

    Article  PubMed  Google Scholar 

  29. Shao Y, Redfors B, Täng MS, Möllmann H, Troidl C, Szardien S, Hamm C, Nef H, Borén J, Omerovic E (2013) Novel rat model reveals important roles of β-adrenoreceptors in stress-induced cardiomyopathy. Int J Cardiol 168(3):1943–1950

    Article  PubMed  Google Scholar 

  30. Redfors B, Shao Y, Wikström J, Lyon AR, Oldfors A, Gan L-M, Omerovic E (2013) Contrast echocardiography reveals apparently normal coronary perfusion in a rat model of stress-induced (Takotsubo) cardiomyopathy. Eur Heart J Cardiovasc Imaging 15(2):152–157

    Article  PubMed  Google Scholar 

  31. Redfors B, Oras J, Shao Y, Seemann-Lodding H, Ricksten S-E, Omerovic E (2014) Cardioprotective effects of isoflurane in a rat model of stress-induced cardiomyopathy (takotsubo). Int J Cardiol 176(3):815–821

    Article  PubMed  Google Scholar 

  32. Sachdeva J, Dai W, Kloner RA (2014) Functional and histological assessment of an experimental model of Takotsubo’s cardiomyopathy. J Am Heart Assoc 3(3):e000921

    Article  PubMed  PubMed Central  Google Scholar 

  33. Kołodzińska A, Czarzasta K, Szczepankiewicz B, Główczyńska R, Fojt A, Ilczuk T, Budnik M, Krasuski K, Folta M, Cudnoch-Jędrzejewska A (2018) Toll-like receptor expression and apoptosis morphological patterns in female rat hearts with takotsubo syndrome induced by isoprenaline. Life Sci 199:112–121

    Article  PubMed  CAS  Google Scholar 

  34. Abraham J, Mudd JO, Kapur N, Klein K, Champion HC, Wittstein IS (2009) Stress cardiomyopathy after intravenous administration of catecholamines and beta-receptor agonists. J Am Coll Cardiol 53(15):1320–1325

    Article  CAS  PubMed  Google Scholar 

  35. Randall WC, Szentivanyi M, Pace JB, Wechsler JS, Kaye MP (1968) Patterns of sympathetic nerve projections onto the canine heart. Circ Res 22(3):315–323

    Article  CAS  PubMed  Google Scholar 

  36. Kawano H, Okada R, Yano K (2003) Histological study on the distribution of autonomic nerves in the human heart. Heart Vessel 18(1):32–39

    Article  Google Scholar 

  37. Kimura K, Ieda M, Fukuda K (2012) Development, maturation, and transdifferentiation of cardiac sympathetic nerves. Circ Res 110(2):325–336

    Article  CAS  PubMed  Google Scholar 

  38. Vincentz JW, Rubart M, Firulli AB (2012) Ontogeny of cardiac sympathetic innervation and its implications for cardiac disease. Pediatr Cardiol 33(6):923–928

    Article  PubMed  PubMed Central  Google Scholar 

  39. Zaroff JG, Rordorf GA, Ogilvy CS, Picard MH (2000) Regional patterns of left ventricular systolic dysfunction after subarachnoid hemorrhage: evidence for neurally mediated cardiac injury. J Am Soc Echocardiogr 13(8):774–779

    Article  CAS  PubMed  Google Scholar 

  40. Vriz O, Minisini R, Citro R, Guerra V, Zito C, De Luca G, Pavan D, Pirisi M, Limongelli G, Bossone E (2011) Analysis of β1 and β2-adrenergic receptors polymorphism in patients with apical ballooning cardiomyopathy. Acta Cardiol 66(6):787–790

    Article  PubMed  Google Scholar 

  41. Mason DA, Moore JD, Green SA, Liggett SB (1999) A gain-of-function polymorphism in a G-protein coupling domain of the human β1-adrenergic receptor. J Biol Chem 274(18):12670–12674

    Article  CAS  PubMed  Google Scholar 

  42. Sandilands A, O’shaughnessy K, Brown M (2003) Greater inotropic and cyclic AMP responses evoked by noradrenaline through Arg389 β1-adrenoceptors versus Gly389 β1-adrenoceptors in isolated human atrial myocardium. Br J Pharmacol 138(2):386–392

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Bruck H, Leineweber K, Temme T, Weber M, Heusch G, Philipp T, Brodde O-E (2005) The Arg389Gly beta1-adrenoceptor polymorphism and catecholamine effects on plasma-renin activity. J Am Coll Cardiol 46(11):2111–2115

    Article  CAS  PubMed  Google Scholar 

  44. Sharkey SW, Maron BJ, Nelson P, Parpart M, Maron MS, Bristow MR (2009) Adrenergic receptor polymorphisms in patients with stress (tako-tsubo) cardiomyopathy. J Cardiol 53(1):53–57

    Article  PubMed  Google Scholar 

  45. Spinelli L, Trimarco V, Di Marino S, Marino M, Iaccarino G, Trimarco B (2010) L41Q polymorphism of the G protein coupled receptor kinase 5 is associated with left ventricular apical ballooning syndrome. Eur J Heart Fail 12(1):13–16

    Article  CAS  PubMed  Google Scholar 

  46. Figtree GA, Bagnall RD, Abdulla I, Buchholz S, Galougahi KK, Yan W, Tan T, Neil C, Horowitz JD, Semsarian C, Ward MR (2013) No association of G-protein-coupled receptor kinase 5 or beta-adrenergic receptor polymorphisms with Takotsubo cardiomyopathy in a large Australian cohort. Eur J Heart Fail 15(7):730–733. https://doi.org/10.1093/eurjhf/hft040

    Article  CAS  PubMed  Google Scholar 

  47. Klein C, Hiestand T, Ghadri J-R, Templin C, Jäncke L, Hänggi J (2017) Takotsubo syndrome–predictable from brain imaging data. Sci Rep 7:5434

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  48. Wittstein IS, Thiemann DR, Lima JA, Baughman KL, Schulman SP, Gerstenblith G, Wu KC, Rade JJ, Bivalacqua TJ, Champion HC (2005) Neurohumoral features of myocardial stunning due to sudden emotional stress. N Engl J Med 352(6):539–548

    Article  CAS  PubMed  Google Scholar 

  49. Kume T, Kawamoto T, Okura H, Toyota E, Neishi Y, Watanabe N, Hayashida A, Okahashi N, Yoshimura Y, Saito K (2008) Local release of catecholamines from the hearts of patients with tako-tsubo-like left ventricular dysfunction. Circ J 72(1):106–108

    Article  CAS  PubMed  Google Scholar 

  50. Morel O, Sauer F, Imperiale A, Cimarelli S, Blondet C, Jesel L, Trinh A, De Poli F, Ohlmann P, Constantinesco A (2009) Importance of inflammation and neurohumoral activation in Takotsubo cardiomyopathy. J Card Fail 15(3):206–213

    Article  CAS  PubMed  Google Scholar 

  51. Shams Y, Henareh L (2015) Plasma catecholamine levels in patients with takotsubo syndrome: implications for the pathogenesis of the disease. Int J Cardiol 181:35–38

    Article  Google Scholar 

  52. Akashi Y, Barbaro G, Sakurai T, Nakazawa K, Miyake F (2007) Cardiac autonomic imbalance in patients with reversible ventricular dysfunction takotsubo cardiomyopathy. Journal of the Association of Physicians 100(6):335–343

    Article  CAS  Google Scholar 

  53. Madhavan M, Borlaug BA, Lerman A, Rihal CS, Prasad A (2009) Stress hormone and circulating biomarker profile of apical ballooning syndrome (Takotsubo cardiomyopathy): insights into the clinical significance of B-type natriuretic peptide and troponin levels. Heart 95(17):1436–1441

    Article  CAS  PubMed  Google Scholar 

  54. Pinkham MI, Barrett CJ (2015) Estradiol alters the chemosensitive cardiac afferent reflex in female rats by augmenting sympathoinhibition and attenuating sympathoexcitation. Clin Exp Pharmacol Physiol 42(6):622–631

    Article  CAS  PubMed  Google Scholar 

  55. Saleh TM, Connell BJ (2000) 17β-Estradiol modulates baroreflex sensitivity and autonomic tone of female rats. J Auton Nerv Syst 80(3):148–161

    Article  CAS  PubMed  Google Scholar 

  56. Gautam S, Shankar N, Tandon OP, Goel N (2011) Comparison of cardiac autonomic functions among postmenopausal women with and without hormone replacement therapy, and premenopausal women

  57. Hart EC, Charkoudian N, Joyner MJ, Barnes JN, Curry TB, Casey DP (2013) Relationship between sympathetic nerve activity and aortic wave reflection characteristics in postmenopausal women. Menopause (New York, NY) 20(9):967

    Article  Google Scholar 

  58. Perseguini NM, de Medeiros Takahashi AC, Milan JC, Dos Santos PR, Neves VFC, Borghi-Silva A, Silva E, Montano N, Porta A, Catai AM (2014) Effect of hormone replacement therapy on cardiac autonomic modulation. Clin Auton Res 24(2):63–70

    Article  PubMed  Google Scholar 

  59. Lavi S, Nevo O, Thaler I, Rosenfeld R, Dayan L, Hirshoren N, Gepstein L, Jacob G (2007) Effect of aging on the cardiovascular regulatory systems in healthy women. Am J Phys Regul Integr Comp Phys 292(2):R788–R793

    CAS  Google Scholar 

  60. Giavarini A, Chedid A, Bobrie G, Plouin P-F, Hagège A, Amar L (2013) Acute catecholamine cardiomyopathy in patients with phaeochromocytoma or functional paraganglioma. Heart 99(19):1438–1444

    Article  PubMed  Google Scholar 

  61. Brugts JJ, van Gent M, Caliskan K, Kofflard MJ (2014) Repetitive stress-induced cardiomyopathy due to inverted Takotsubo in exaggerated sympathetic stimulation by pheochromocytoma. Eur Heart J Cardiovasc Imaging 16(1):113–113

    Article  PubMed  Google Scholar 

  62. Gagnon N, Mansour S, Bitton Y, Bourdeau I (2017) Takotsubo-like cardiomyopathy in a large cohort of patients with pheochromocytoma and paraganglioma. Endocr Pract 23:1178–1192

    Article  PubMed  Google Scholar 

  63. Coupez E, Eschalier R, Pereira B, Pierrard R, Souteyrand G, Clerfond G, Citron B, Lusson J-R, Mansencal N, Motreff P (2014) A single pathophysiological pathway in Takotsubo cardiomyopathy: catecholaminergic stress. Arch Cardiovasc Dis 107(4):245–252

    Article  PubMed  Google Scholar 

  64. Finsterer J, Wahbi K (2014) CNS disease triggering Takotsubo stress cardiomyopathy. Int J Cardiol 177(2):322–329

    Article  PubMed  Google Scholar 

  65. Porto I, Della Bona R, Leo A, Proietti R, Pieroni M, Caltagirone C, Spalletta G, Bolognese L, Cravello L (2013) Stress cardiomyopathy (tako-tsubo) triggered by nervous system diseases: a systematic review of the reported cases. Int J Cardiol 167(6):2441–2448

    Article  PubMed  Google Scholar 

  66. Khurana RK (2008) Takotsubo cardiomyopathy in a patient with postural tachycardia syndrome. Clin Auton Res 18(1):43–47

    Article  PubMed  Google Scholar 

  67. Harris ZM, Alonso A, Kennedy TP (2016) Adrenergic inhibition with dexmedetomidine to treat stress cardiomyopathy during alcohol withdrawal: a case report and literature review. Case reports in critical care 2016, 1, 9

  68. Sarcon A, Ghadri J-R, Wong G, Lüscher TF, Templin C, Amsterdam E (2013) Takotsubo cardiomyopathy associated with opiate withdrawal. QJM: An International Journal of Medicine 107(4):301–302

    Article  Google Scholar 

  69. Arora S, Alfayoumi F, Srinivasan V (2006) Transient left ventricular apical ballooning after cocaine use: is catecholamine cardiotoxicity the pathologic link? Mayo Clin Proc 81(6):829-32

  70. Sharp RP, Welch EB (2011) Takotsubo cardiomyopathy as a complication of electroconvulsive therapy. Ann Pharmacother 45(12):1559–1565

    Article  PubMed  Google Scholar 

  71. Madias JE (2016) Low prevalence of diabetes mellitus in patients with Takotsubo syndrome: a plausible ‘protective’ effect with pathophysiologic connotations. Eur Heart J Acute Cardiovasc Care 5(2):164–170

    Article  PubMed  Google Scholar 

  72. Madias JE (2016) Details about diabetes mellitus in reported patients with Takotsubo syndrome, and its importance in unraveling the pathophysiology of the disease. Int J Cardiol 209:70–71

    Article  PubMed  Google Scholar 

  73. Madias JE (2016) An animal model of diabetic peripheral neuropathy and the pathophysiology of takotsubo syndrome: a proposal of an experiment. Int J Cardiol 222:882–884

    Article  PubMed  Google Scholar 

  74. Burgdorf C, Richardt D, Kurz T, Adler S, Nötzold A, Kraatz E, Sievers H, Richardt G (2003) Norepinephrine release is reduced in cardiac tissue of type 2 diabetic patients. Diabetologia 46(4):520–523

    Article  CAS  PubMed  Google Scholar 

  75. Stiermaier T, Moeller C, Oehler K, Desch S, Graf T, Eitel C, Vonthein R, Schuler G, Thiele H, Eitel I (2016) Long-term excess mortality in Takotsubo cardiomyopathy: predictors, causes and clinical consequences. Eur J Heart Fail 18(6):650–656

    Article  PubMed  Google Scholar 

  76. Shams Y (2015) The pathogenesis of reversible T-wave inversions or large upright peaked T-waves: sympathetic T-waves. Int J Cardiol 191:237–243

    Article  Google Scholar 

  77. Shams Y (2015) RESPONSE: the electrocardiographic changes in mid-basal (inverted) Takotsubo syndrome. Ann Noninvasive Electrocardiol 6(20):614–614

    Google Scholar 

  78. Duran-Cambra A, Sutil-Vega M, Fiol M, Núñez-Gil I, Vila M, Sans-Roselló J, Cinca J, Sionis A (2015) Systematic review of the electrocardiographic changes in the takotsubo syndrome. Ann Noninvasive Electrocardiol 20(1):1–6

    Article  CAS  PubMed  Google Scholar 

  79. Abildskov J (1976) Adrenergic effects on the QT interval of the electrocardiogram. Am Heart J 92(2):210–216

    Article  CAS  PubMed  Google Scholar 

  80. Magnano AR, Talathoti N, Hallur R, Bloomfield DM, Garan H (2006) Sympathomimetic infusion and cardiac repolarization: the normative effects of epinephrine and isoproterenol in healthy subjects. J Cardiovasc Electrophysiol 17(9):983–989

    Article  PubMed  Google Scholar 

  81. Marra MP, Zorzi A, Corbetti F, De Lazzari M, Migliore F, Tona F, Tarantini G, Iliceto S, Corrado D (2013) Apicobasal gradient of left ventricular myocardial edema underlies transient T-wave inversion and QT interval prolongation (Wellens’ ECG pattern) in Tako-Tsubo cardiomyopathy. Heart Rhythm 10(1):70–77

    Article  Google Scholar 

  82. Lee J-H, Uhm J-S, Shin DG, Joung B, Pak H-N, Ko Y-G, Hong G-R, Lee M-H (2016) Clinical significance of changes in the corrected QT interval in stress-induced cardiomyopathy. Korean J Intern Med 31(3):507–516

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  83. Santoro F, Brunetti ND, Tarantino N, Romero J, Guastafierro F, Ferraretti A, Di Martino LF, Ieva R, Pellegrino PL, Di Biase M (2017) Dynamic changes of QTc interval and prognostic significance in takotsubo (stress) cardiomyopathy. Clin Cardiol 40:1116–1122

    Article  PubMed  PubMed Central  Google Scholar 

  84. Waldenborg M, Soholat M, Kähäri A, Emilsson K, Fröbert O (2011) Multidisciplinary assessment of tako tsubo cardiomyopathy: a prospective case study. BMC Cardiovasc Disord 11(1):14

    Article  PubMed  PubMed Central  Google Scholar 

  85. Ortak J, Khattab K, Barantke M, Wiegand UK, Baensch D, Ince H, Nienaber CA, Bonnemeier H (2009) Evolution of cardiac autonomic nervous activity indices in patients presenting with transient left ventricular apical ballooning. Pacing Clin Electrophysiol 32(s1):S21–S25

    Article  PubMed  Google Scholar 

  86. Madias JE (2016) Do we need MIBG in the evaluation of patients with suspected Takotsubo syndrome? Diagnostic, prognostic, and pathophysiologic connotations. Int J Cardiol 203:783–784

    Article  PubMed  Google Scholar 

  87. Sverrisdóttir YB, Schultz T, Omerovic E, Elam M (2012) Sympathetic nerve activity in stress-induced cardiomyopathy. Clin Auton Res 22(6):259–264

    Article  PubMed  PubMed Central  Google Scholar 

  88. Vaccaro A, Despas F, Delmas C, Lairez O, Lambert E, Lambert G, Labrunee M, Guiraud T, Esler M, Galinier M (2014) Direct evidences for sympathetic hyperactivity and baroreflex impairment in Tako Tsubo cardiopathy. PLoS One 9(3):e93278

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  89. Norcliffe-Kaufmann L, Kaufmann H, Martinez J, Katz SD, Tully L, Reynolds HR (2016) Autonomic findings in Takotsubo cardiomyopathy. Am J Cardiol 117(2):206–213

    Article  PubMed  Google Scholar 

  90. Ali A, Redfors B, Omerovic E (2015) How baroreceptor dysfunction could predispose to the takotsubo syndrome. Int J Cardiol 182:105–106

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Agnieszka Cudnoch-Jędrzejewska.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standards

The manuscript does not contain clinical studies or patient data.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Borodzicz, S., Czarzasta, K., Opolski, G. et al. Autonomic nervous system in Takotsubo syndrome. Heart Fail Rev 24, 101–108 (2019). https://doi.org/10.1007/s10741-018-9729-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10741-018-9729-5

Keywords

Navigation