While reading Lorna's post on cardiac syndrome X, a
cardiac condition I came across in my clinical practice
came to mind as it shares similar characteristics to
cardiac syndrome X. Takotsubo also known as transient
left ventricular apical ballooning is a syndrome first
discovered in Japan meaning "fishing pot for trappinmg
octopus" (Virani et al., 2007, p.76). This syndrome is
defined as a non-ischemic, stress-induced cardimyopathy
also termed 'broken heart syndome (Wikipedia
encyclopedia). Takotsubo can be characterized by sudden
onset of CHF, associated EKG changes suggestive of
anterior wall myocardial infartion,prolonged QT
interval, and elevated cardiac markers in the presence
of normal coronary arteries post angiogram (Virani et
al., 2007). There is still much speculation of its
etiology, but the most supported thought is that it is a
condition trigerred by emotional stress, often a death
of a loved one, that presents as systolic ballooning of
the apex and hypercontraction of basal segment in
response to catecholamine release provoked byemotional
stress (Bybee et al., 2004). Other possible causes of
left ventricular apical balloning have been associated
with multivessel epicardial spasm, microvascular
coronary spasm, and neurogenic mediated myocardial
stunning(Virani et al., 2007). Researchers believe that
the apex of the heart is mainly affected as it has
increased adrenergic receptor density in the cardiac
apical segments, or increased adrenergic reponse to
stimulation (Bybee et al., 2004; Virani et al., 2007).  
What I found interesting is that this particular
syndrome is experienced most often in postmenopausal
women. Virani et al. (2007) attributes this to
"postmenopausal alterations of endothelial function in
response to reduced estrogen levels and microvasculatory
vasomotor reactivity in response to
chatecholamine-mediated stimuli" (p.864).  What
interrested me the most as in cardiac syndrome X is the
way these syndromes present, they are very interesting
and somewhat of a mystery. Takotsubo is of paritcular
interest to me as I had a patient who found her husband 
 on the driveway dead from a massive MI, the next day
she was in our unit with a broken heart. truly sad and
heart wrentching. Andria 

Bybee, K., Kara, T., Prasad, A., Lerman, A., Brasnees,
G., Wright, S., & Rihal, C.S. (2004). Annals of Internal
Medicine, 141, 858-865.

Virani, S.S., Khan, A.N., Mendoza, C.E., Ferreira, A.C.,
& Marchena, E. (2007). Texas Heart Intitute journal,
34(1), 76-79.

Takotsubo cardiomyopathy-Wikipedia, the free
encyclopedia. Retrieved July 2, 2008 from,
http://en.wikipedia.org/wiki/Takotsubo_cardimyopathy.