Key result
Preclinical Takotsubo syndrome is proposed to precipitate SCAD via mechanical disruption at the myocardial hinge.
Why the study?
Takotsubo syndrome and spontaneous coronary artery dissection are increasingly recognized as associated, but their pathophysiologic relationship and potential causal links remain debated.
This review proposes a novel pathophysiological mechanism by which takotsubo syndrome could precipitate spontaneous coronary artery dissection through mechanical disruption at the myocardial hinge pivoting point.
Hypothesis-generating link between takotsubo and SCAD; requires prospective validation before any clinical consideration.
It is increasingly apparent that takotsubo syndrome (TTS) and spontaneous coronary artery dissection (SCAD) are associated. While the pathophysiology of TTS and SCAD are still debated, there should not be much doubt that SCAD could trigger TTS, as the latter often emerges in the context of a great variety of physical and emotional stresses, and thus SCAD should not be excluded as a TTS precipitant. In regards to TTS precipitating SCAD, it has been proposed that the anatomic junction of vigorously contracting base of the heart and the abutting akinetic/dyskinetic mid-ventricular/apical myocardium, could form a "hinge pivoting point", exerting a disrupting mechanical influence on the coronary vessels crossing these 2 planes, precipitating tearing of the coronary vessel wall, formation of an intramural hematoma, with resultant SCAD in susceptible individuals. This review also provides a detailed list of recommendations for exploring the plausible association of TTS and SCAD, irrespective of their temporal sequence of occurrence.
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J. E. Madias (2024) conducted a review in Takotsubo syndrome and spontaneous coronary artery dissection. Preclinical takotsubo syndrome was evaluated. Preclinical takotsubo syndrome is proposed as a potential precipitant of spontaneous coronary artery dissection due to mechanical disruption at the myocardial hinge pivoting point.
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