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Psychosocial and psychoneuroendocrinal aspects of Takotsubo syndrome

Nature Reviews Cardiology volume 13, pages 688–694 (2016)Cite this article

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Abstract

Great advances have been made in our understanding of Takotsubo syndrome in the past decade, but the aetiology of the condition remains incompletely understood. The most established theory, that catecholamine-mediated myocardial stunning is provoked by emotional or physiological stress, is supported by the presence of supraphysiological levels of plasma catecholamines in patients with Takotsubo syndrome. For this reason, the hyperexcitability of the autonomic nervous system under conditions of physical and emotional stress is often assessed in these patients. Observational studies have indicated that a predisposing influence of chronic or traumatic stress, anxiodepressive disorders, and maladaptive personality traits are linked to the pathogenesis of Takotsubo syndrome. Chronic stress can influence autonomic function through dysregulation of the hypothalamic–pituitary–adrenal axis and contribute to the development of cardiovascular disorders. In this Perspectives article, we discuss the current knowledge of the psychoneuroendocrinological and psychosocial mechanisms underlying the pathophysiology of Takotsubo syndrome.

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Figure 1: Proposed mechanism linking psychoneuroendocrinological factors and Takotsubo syndrome (TTS).

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Authors and Affiliations

  1. Germany; and at the Department of Heart Surgery, Sabrina Kastaun is at the Institute of General Practice, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Kerckhoff Heart and Thorax Center, Benekestrasse 2–8, 61231 Bad Nauheim, Germany.,

    Sabrina Kastaun

  2. the Department of Neurology, Heart & Brain Research Group, University Hospital Giessen and Marburg, Klinikstrasse 33, 35392 Giessen, Germany,

    Sabrina Kastaun

  3. Tibo Gerriets is at the Department of Neurology, Heart & Brain Research Group, University Hospital Giessen and Marburg, Klinikstrasse 33, 35392 Giessen, Germany,

    Tibo Gerriets

  4. and at the Department of Neurology, Gesundheitszentrum Wetterau, Chaumontplatz 1, 61231 Bad Nauheim, Germany.,

    Tibo Gerriets

  5. Marlene Tschernatsch and Martin Juenemann are at the Department of Neurology, Mesut Yeniguen, Heart & Brain Research Group, University Hospital Giessen and Marburg, Klinikstrasse 33, 35392 Giessen, Germany.,

    Marlene Tschernatsch, Mesut Yeniguen & Martin Juenemann

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M.J. and S.K. researched data for the article, discussed its content, and wrote, reviewed, and edited the manuscript before submission. T.G. and M.T. discussed the content of the article and reviewed and edited the manuscript before submission. M.Y. researched data for the article and discussed its content.

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Kastaun, S., Gerriets, T., Tschernatsch, M. et al. Psychosocial and psychoneuroendocrinal aspects of Takotsubo syndrome. Nat Rev Cardiol 13, 688–694 (2016). https://doi.org/10.1038/nrcardio.2016.108

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