Review
CNS disease triggering Takotsubo stress cardiomyopathy☆

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Abstract

There are a number of hereditary and non-hereditary central nervous system (CNS) disorders, which directly or indirectly affect the heart (brain–heart disorders). The most well-known of these CNS disorders are epilepsy, stroke, infectious or immunological encephalitis/meningitis, migraine, and traumatic brain injury. In addition, a number of hereditary and non-hereditary neurodegenerative disorders may impair cardiac functions. Affection of the heart may manifest not only as arrhythmias, myocardial infarction, autonomic impairment, systolic dysfunction/heart failure, arterial hypertension, or pulmonary hypertension, but also as stress cardiomyopathy (Takotsubo syndrome, TTS). CNS disease triggering TTS includes subarachnoid bleeding, epilepsy, ischemic stroke, intracerebral bleeding, migraine, encephalitis, traumatic brain injury, PRES syndrome, or ALS. Usually, TTS is acutely precipitated by stress triggered by various different events. TTS is one of the cardiac abnormalities most frequently induced by CNS disorders. Appropriate management of TTS from CNS disorders is essential to improve the outcome of affected patients.

Introduction

Central nervous system (CNS) disease may cause a number of cardiac abnormalities (brain–heart disorders (BHDs)) which may include stress cardiomyopathy, also known as Takotsubo syndrome (TTS), apical ballooning, Takotsubo cardiomyopathy, broken–heart syndrome, transient regional left ventricular dysfunction, transient myocardial dysfunction (MI), transient systolic dysfunction, neurogenic stunned myocardium, neurogenic stressed myocardium, catecholamine cardiomyopathy, neurogenic stress cardiomyopathy, or reversible acute heart failure [1]. The mechanism by which CNS disease induces TTS is most likely catecholamine stress induced by fear, pain, or anxiety [2]. This mini-review aims at providing an overview about the current knowledge concerning CNS disorders triggering TTS.

Section snippets

Method

Data for this review were identified by searches in MEDLINE, Current Contents, and references from relevant articles using the search terms “central nervous system”, “cerebral”, “brain”, “autonomous nervous system”, “sympathetic”, “parasympathetic”, “stroke”, “intracerebral bleeding”, “subarachnoid bleeding”, “seizure”, “epilepsy”, “traumatic brain injury”, “migraine”, “central sleep apnea syndrome”, “restless leg syndrome”, “Parkinson syndrome”, and “amyotrophic lateral sclerosis” in

Definition

Various attempts have been undertaken to unambiguously describe and define TTS. These efforts resulted in the creation of the Mayo Clinic Criteria, the revised Mayo Clinic Criteria, the criteria of the Japanese Circulation Society, the John Hopkins criteria, and the Madias criteria [4]. The American Heart Association (AHA) and the European Heart Association (EHA) follow in their cardiomyopathy guidelines these criteria and classify TTS as an unclassified cardiomyopathy characterized by

Discussion

This review shows that psychological or physical stress from an acute CNS disorder due to anxiety, pain, uncertainty, or confusion may induce a catecholamine storm or catecholamine shock. This sympathetic overstimulation may promote the development of TTS. TTS is an increasingly recognized phenomenon associated with CNS disease or other conditions triggering catecholamine release. Though catecholamine stress can be triggered by any condition inducing stress, CNS disorders are unique since the

Conflict of interest

JF and KW have nothing to declare.

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    ☆

    Contribution of authors: JF designed the review, organized the literature, and wrote the first draft of the manuscript. KW completed the literature search, supported in the writing, and provided critical comments.

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