Do comorbid psychiatric disorders contribute to the pathogenesis of tako-tsubo syndrome? A review of pathogenesis

Patients with tako-tsubo cardiomyopathy have unusual characteristics, including a disproportionate occurrence in postmenopausal women and a strong association with mental and physical stress. These patients present with chest pain, abnormal electrocardiographic findings, and myocardial enzyme leaks. They appear to have acute coronary syndrome but have normal epicardial coronary vessels and reversible left ventricular dysfunction. High circulating levels of catecholamines likely cause this syndrome through direct injury of myocardial cells. The frequent occurrence in postmenopausal women has not been explained. This association might reflect changes in autonomic control of the cardiovascular system and in baroreceptor sensitivity in postmenopausal women. Women in this age group also have a high frequency of both depression and anxiety. These 2 psychiatric diagnoses are associated with episodic symptoms, including acute panic attacks, which can be associated with catecholamine release in the heart. Therefore, tako-tsubo cardiomyopathy may occur in postmenopausal women as a consequence of comorbid psychiatric diagnoses and normal age-related changes in autonomic control of the cardiovascular system. This hypothesis warrants prospective case-control studies.