{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T21:58:39Z","timestamp":1792447119697,"version":"4.5.0"},"reference-count":165,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2023,5,15]],"date-time":"2023-05-15T00:00:00Z","timestamp":1684108800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,7,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Takotsubo syndrome (TTS) accounts for between 1 and 4% of cases presenting clinically as an acute coronary syndrome. It typically presents as a transient cardiac phenotype of left ventricular dysfunction with spontaneous recovery. More dramatic presentations may include cardiogenic shock or cardiac arrest. Despite progress in the understanding of the condition since its first description in 1990, considerable questions remain into understanding underlying pathomechanisms. In this review article, we describe the current published data on potential underlying mechanisms associated with the onset of TTS including sympathetic nervous system over-stimulation, structural and functional alterations in the central nervous system, catecholamine secretion, alterations in the balance and distribution of adrenergic receptors, the additive impact of hormones including oestrogen, epicardial coronary or microvascular spasm, endothelial dysfunction, and genetics as potentially contributing to the cascade of events leading to the onset. These pathomechanisms provide suggestions for novel potential therapeutic strategies in patients with TTS including the role of cognitive behavioural therapy, beta-blockers, and endothelin-A antagonists. The underlying mechanism of TTS remains elusive. In reality, physical or emotional stressors likely trigger through the amygdala and hippocampus a central neurohumoral activation with the local and systemic secretion of excess catecholamine and other neurohormones, which exert its effect on the myocardium through a metabolic switch, altered cellular signalling, and endothelial dysfunction. These complex pathways exert a regional activation in the myocardium through the altered distribution of adrenoceptors and density of autonomic innervation as a protective mechanism from myocardial apoptosis. More research is needed to understand how these different complex mechanisms interact with each other to bring on the TTS phenotype.<\/jats:p>","DOI":"10.1093\/cvr\/cvad053","type":"journal-article","created":{"date-parts":[[2023,5,15]],"date-time":"2023-05-15T03:14:15Z","timestamp":1684120455000},"page":"1480-1494","source":"Crossref","is-referenced-by-count":47,"title":["Takotsubo syndrome: getting closer to its causes"],"prefix":"10.1093","volume":"119","author":[{"given":"Mohammed Majid","family":"Akhtar","sequence":"first","affiliation":[{"name":"Royal Brompton and Harefield Hospitals, Imperial College and King\u2019s College , London SW3 6NP , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7240-6593","authenticated-orcid":false,"given":"Victoria L","family":"Cammann","sequence":"additional","affiliation":[{"name":"University Heart Center, Department of Cardiology, University Hospital Z\u00fcrich , Z\u00fcrich 8091 , Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0287-4193","authenticated-orcid":false,"given":"Christian","family":"Templin","sequence":"additional","affiliation":[{"name":"University Heart Center, Department of Cardiology, University Hospital Z\u00fcrich , Z\u00fcrich 8091 , Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4862-0562","authenticated-orcid":false,"given":"Jelena R","family":"Ghadri","sequence":"additional","affiliation":[{"name":"University Heart Center, Department of Cardiology, University Hospital Z\u00fcrich , Z\u00fcrich 8091 , Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5259-538X","authenticated-orcid":false,"given":"Thomas F","family":"L\u00fcscher","sequence":"additional","affiliation":[{"name":"Royal Brompton and Harefield Hospitals, Imperial College and King\u2019s College , London SW3 6NP , UK"},{"name":"Center for Molecular Cardiology, University of Z\u00fcrich , Z\u00fcrich 8952 , Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,5,15]]},"reference":[{"key":"2023070407062564200_cvad053-B1","first-page":"56","volume-title":"Takotsubo Type Cardiomyopathy Due to Multivessel Spasm in Clinical Aspect of Myocardial Injury: From Ischemia to Heart Failure","author":"Satoh","year":"1990"},{"key":"2023070407062564200_cvad053-B2","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1002\/ccd.23441","article-title":"Incidence and angiographic characteristics of patients with apical ballooning syndrome (Takotsubo\/stress cardiomyopathy) in the HORIZONS-AMI trial: an analysis from a multicenter, international study of ST-elevation myocardial infarction","volume":"83","author":"Prasad","year":"2014","journal-title":"Catheter Cardiovasc 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