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Review
. 2019 Oct 23;11(10):e5972.
doi: 10.7759/cureus.5972.

Takotsubo Cardiomyopathy: Understanding the Pathophysiology of Selective Left Ventricular Involvement

Deepak Kumar Pasupula  1 , Venkata Suresh Patthipati  2 , Awais Javed  1 , Sudeep K Siddappa Malleshappa  3
Affiliations
Review

Takotsubo Cardiomyopathy: Understanding the Pathophysiology of Selective Left Ventricular Involvement

Deepak Kumar Pasupula et al. Cureus. .

Abstract

Takotsubo cardiomyopathy (TCM) has gained global recognition as a unique cardiovascular disease that mimics acute myocardial infarction. Since its initial description, more than three decades ago, we have significantly advanced our understanding of diagnosing, treating, and prognosticating this reversible cardiovascular phenomenon. However, the pathophysiological explanation behind its selective involvement of the left ventricle (LV), predominantly the LV apex in poorly understood. In this brief review on differential distribution of the adrenergic nerve (AN) and cholinergic nerve (CN) in the normal human heart, we try to extrapolate an idea of poor CN distribution in the LV apex as an associated factor augmenting microcirculatory dysfunction due to an unopposed AN activity from the catecholamine surge, as a plausible explanation for this characteristic phenomenon.

Keywords: adrenergic receptors; cholinergic receptors; coronary microcirculation; pathophysiology; takotsubo cardiomyopathy.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Schematic recreation of the adrenergic and cholinergic nerve distribution in normal ventricles
A higher ratio of adrenergic nerve: cholinergic nerve is noted in the left ventricle apex which is due to the low density of cholinergic nerves. RV: right ventricle, LV:  left ventricle.
See this image and copyright information in PMC

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