Association of prolonged QTc interval with Takotsubo cardiomyopathy: A neurocardiac syndrome inside the mystery of the insula of Reil

Abstract

The Takotsubo cardiomyopathy is often considered autochthonous to the heart, although the primary problem may be not in the heart muscle itself. Instead, similar to several Takotsubo-like cardiac pathologies seen in acute neurological diseases, it may reflect the capacity of the nervous system to injure the heart. Persuasive evidence exists that shocking emotional stress promotes direct heart injuries. Moreover, clinical and laboratory research shows that cardiac structural damage can occur in the presence of a normal heart, especially in the context of seizures, stroke, and traumatic brain injury or under conditions of psychological stress. The aim of this review is to summarize the clinical implications of these observations, several of which focus on the pivotal role of the insula of Reil in the brain-heart connection, to unravel the mystery of Takotsubo cardiomyopathy pathogenesis.

Keywords: Insula of Reil; QTc Interval; Takotsubo Cardiomyopathy; Ventricular Repolarization.

Figure 1

Magnificent copper engravings of cardiac nervi and arteriae coronariae in cordis facies superior (left) and complanata (right) depicted by Faustino Anderloni after Antonio Scarpa's own drawings in Tabulae Neurologicae Ad Illustrandam Historiam Anatomicam (1794).46 Scarpa first accurately illustrated the innervation of the heart, showing in this atlas that the terminal ramifications of the cardiac nerves are directly connected to the muscle fibers of the heart. Letter and number abbreviations name, respectively, coronary vessels and cardiac nerves; further explanations in the original text. University Library Heidelberg, Germany. Image in the public domain from wikisource: http://digi.ub.uni‐heidelberg.de/diglit/scarpa1794