Takotsubo cardiomyopathy - Knowledge (XXG)

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protection to women by improving blood flow to heart muscle, is one biochemical pathway implicated in the TTS disease process. Once this protective mechanism is reduced through the decreased production of estrogen after menopause, there is thought to be an increase in endothelial dysfunction predisposing an individual to vasoconstriction and cardiac ischemia. An inciting stressful event elicits the release of catecholamines into the blood stream to create increased heart muscle activity and metabolism. This leads to further cardiac microvascular endothelial dysfunction through oxidative stress, alteration of ion-mediated channels, and electrolyte disturbances which ultimately alter myocardial cell membrane permeability and dysfunction. Coupled with direct heart muscle toxicity, this crescendo of factors are implicated in the ballooning and heart failure characteristically seen in TTS.

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long-term prognosis is excellent for most. Even when ventricular systolic function is heavily compromised at presentation, it typically improves within the first few days and normalises within the first few months. Although infrequent, recurrence of the syndrome has been reported and seems to be associated with the nature of the trigger. While men experience TTS at much lower rates than women, they also experience much higher rates of complication, reoccurrence, and mortality; the cause of this sex difference is still unknown, but it is hypothesized that the social aspect of the doctor-patient interaction affects the way that physicians recognize and generate individual treatment plans for men compared to women. Stress cardiomyopathy is now a well-recognized cause of acute

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create physiological changes in the receptor which has an inverse effect on cardiac cellular function. Termed 'cellular-trafficking', this property of the cardiac muscle cell is actually a molecular transformation of the cell to produce a down-regulation of catecolaminergic sensitivity. This means that in the presence of excess epinephrine, a normal cardiac contraction is inhibited in an effort to reduce energy demands, prevent hyperactivity and spare the integrity of the cell. Further bolstering this idea is the concentration of these kinds of receptors in the heart. Higher concentrations of the receptor effected to produce cardiac stunning are found closer to the apex of the ventricle. This is what creates the classic ballooning effect of the ventricle.

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that when there are vasospasms, even in multiple arteries, that they do not correlate with the areas of myocardium that are not contracting. However, the idea of coronary artery vasospasm is still believed to contribute to the TTS disease process. The theory of vasospasm is not easily separated from that of microvascular dysfunction and in fact, microvascular dysfunction could explain vasospasticity. Impaired microvascular function is seen in a vast majority, if not all, of patients with TTS and is currently one of the most supported theories. Most of the dysfunction occurs as a result of abnormalities within the

541: 573: 370:. More specifically, adrenal stimulation by the sympathetic nervous system has been noted in cases ranging from physical events such as ischemic stroke, to emotional events such as depression or loss of a loved-one. How these increased levels of catecholamines act in the body to produce the changes seen with TTS is not clearly understood. Research supports the widely-held understanding that microvascular dysfunction and coronary vasospasm caused by a rapid influx of catecholamines to cardiac myocytes results in apical stunning and transient cardiomyopathy. 353:) are common phenomena. A multi-centre observation study found normal thyroid function to be the exception rather than the rule in TTS. Especially hyperthyroidism is highly prevalent in takotsubo cardiomyopathy, and it seems to predict a poor prognosis in terms of complications and mortality. This observation was confirmed by results of the international GEIST registry, which demonstrated that thyrotoxicosis is associated with significantly increased fatality, whereas hypothyroidism indicates a better survival. 589: 397:, released in response to stress) leads to heart muscle dysfunction that contributes to takotsubo cardiomyopathy. The effects of this toxicity can be greater in those with a predisposition to anxiety or panic disorders. Delivery of catecholamines (epinephrine, norepinephrine) via circulating blood and through direct delivery from cardiac nerves is increased by the stimulation of stress control centers of the brain. During an emotionally or physically stressful event, brain centers initiate the 511:. This is accompanied by the lack of significant coronary artery disease that would explain the wall motion abnormalities. Although apical ballooning has been described classically as the angiographic manifestation of takotsubo, it has been shown that left ventricular dysfunction in this syndrome includes not only the classic apical ballooning, but also different angiographic morphologies such as mid-ventricular ballooning and, rarely, local ballooning of other segments. 450:. All of the research institutions agree on at least two main criteria needed to accurately diagnose TTS: 1) transient left ventricular wall motion abnormality and 2) the absence of a condition obviously explaining this wall motion abnormality (coronary artery lesion, hypoperfusion, myocarditis, toxicity, etc.). Other commonly acknowledged criteria necessary for diagnosis include characteristic EKG changes and mild to modest elevation in cardiac 774: 53: 785:

status or self-esteem; (6) personal danger or threat of injury; (7) after the danger is over; (8) reunion, triumph, or happy ending. He proposed these events provoke neurovegetative responses, involving both the flight-fight and conservation-withdrawal systems, conducive to lethal cardiac events, particularly in individuals with preexisting cardiovascular disease.

461:. While the original case studies reported on individuals in Japan, takotsubo cardiomyopathy has been noted more recently in the United States and Western Europe. It is likely that the syndrome previously went undiagnosed before it was described in detail in the Japanese literature. Evaluation of individuals with takotsubo cardiomyopathy typically includes a 123:. Emotional stressors include bereavement, divorce, or the loss of a job. Reviews suggest that of patients diagnosed with the condition, about 70–80% recently experienced a major stressor, including 41–50% with a physical stressor and 26–30% with an emotional stressor. TTS can also appear in patients who have not experienced major stressors. 402:

catecholamines, increases the need for more blood and oxygen to these muscles to sustain function. When these demands are unable to be met, the heart is starved of blood and oxygen and begins to die. Included in the cytotoxic sequela of catecholamine toxicity is the molecular transformation of the cardiac myocyte to produce apical stunning.

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Some of the original researchers of takotsubo suggested that multiple simultaneous spasms of coronary arteries could cause enough loss of blood flow to cause transient stunning of the myocardium. Other researchers have shown that vasospasm is much less common than initially thought. It has been noted

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attack or exacerbation of a chronic illness) and research has indicated that this type of stress may even occur more often than emotionally stressful triggers. Roughly one-third of patients have no preceding stressful event. A 2009 large case series from Europe found that takotsubo cardiomyopathy was

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Weidner, K. J., El-Battrawy, I., Behnes, M., Schramm, K., Fastner, C., Kuschyk, J., Hoffmann, U., & Borggrefe, M. (2017). Therapeutics and Clinical Risk Management Dovepress sex differences of in-hospital outcome and long-term mortality in patients with Takotsubo cardiomyopathy. Therapeutics and

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Takotsubo syndrome represents about 2% of all patients (and 5–6% of all female patients) who are initially diagnosed with acute coronary syndrome (ACS). It accounts for 0.02% of all hospitalizations in the US. About 90% of TTS patients are women, whose mean age is about 68 years, and 80% of whom are

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pathways and increase myocardial activity. Excessive catecholamine stimulation has a toxic effect on cardiac muscle cells which creates necrosis of the contractile units of cells similarly seen during acute myocardial infarction. The increased workload of cardiac muscle created by the stimulation of

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Tsuchihashi K, Ueshima K, Uchida T, Oh-mura N, Kimura K, Owa M, Yoshiyama M, Miyazaki S, Haze K, Ogawa H, Honda T, Hase M, Kai R, Morii I (July 2001). "Transient left ventricular apical ballooning without coronary artery stenosis: a novel heart syndrome mimicking acute myocardial infarction. Angina

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In short, the main criteria for the diagnosis of takotsubo cardiomyopathy are: the patient must have experienced a stressor before the symptoms began to arise; the patient's ECG reading must show abnormalities from a normal heart; the patient must not show signs of coronary blockage or other common

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The cause of takotsubo cardiomyopathy is not fully understood, but several mechanisms have been proposed. It is well documented that elevated catecholamine levels have been implicated in the vast majority of TTS cases. Theories suggest a link between brain activation of stress-related biochemicals

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Engel wrote about sudden and rapid death during psychological stress in 1971 and itemized 8 causation categories: (1) on the impact of the collapse or death of a close person; (2) during acute grief; (3) on threat of loss of a close person; (4) during mourning or on an anniversary; (5) on loss of

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It is currently being investigated if certain genetic traits associated with catecholamine receptors found on cardiac muscle cells play a role in the development of TTS. There is limited evidence tying TTS directly to a specific genetic expression or mutation, however there is currently a widely

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Stress is the main factor in takotsubo cardiomyopathy, with more than 85% of cases set in motion by either a physically or emotionally stressful event that prefaces the start of symptoms. Examples of emotional stressors include grief from the death of a loved one, fear of public speaking, arguing

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The treatment of takotsubo cardiomyopathy is generally supportive in nature, for it is considered a transient disorder. Treatment is dependent on whether patients experience heart failure or acute hypotension and shock. In many individuals, left ventricular function normalizes within two months.

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Although there have been documented cases of TTS without a triggering stressor, it is widely recognized that TTS is preceded by a stressful or emotional event. Case series looking at large groups of patients report that some patients develop takotsubo cardiomyopathy after experiencing emotional

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It has been suggested that a mid-ventricular wall thickening with outflow obstruction is important in the pathophysiology. This stunning is largely seen as a protective effect produced by the flood of excess catecholamines into the cardiac muscle cell. Overstimulation of catecholamine receptors

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linings of blood vessels supplying the heart. In TTS, these highly sensitive interior linings of the vessels have reduced functionality which create dysregulation of vascular tone and predispose the individual to vasoconstriction. When the increased vasoconstrictor effects of catecholamines are

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While medical treatments are important to address the acute symptoms of takotsubo cardiomyopathy, further treatment includes lifestyle changes. It is important that the individual stay physically healthy while learning and maintaining methods to manage stress, and to cope with future difficult

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Despite the grave initial presentation in some of the patients, most of the patients survive the initial acute event, with a very low rate of in-hospital mortality or complications. Once a patient has recovered from the acute stage of the syndrome, they can expect a favorable outcome and the

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and other heart drugs also appear to help in the treatment of this disease, even in extreme cases. After the patient has been diagnosed, and myocardial infarction (heart attack) ruled out, the aspirin regimen may be discontinued, and treatment becomes that of supporting the patient. There is

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It is likely that there are multiple factors at play that could include some amount of vasospasm and failure of the microvasculature. These factors can overlap and create the complex sequela leading to ischemia and left ventricle contraction abnormality. For instance, estrogen, which confers

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Aweimer, Assem; Dietrich, Johannes W.; Santoro, Francesco; Camins Fàbregas, Mireia; Mügge, Andreas; Núñez-Gil, Iván J.; Vazirani, Ravi; Vedia, Oscar; Pätz, Toni; Ragnatela, Ilaria; Arcari, Luca; Volpe, Massimo; Corbì-Pascual, Miguel; Martinez-Selles, Manuel; Almendro-Delia, Manuel; Sionis,

246:. During the course of evaluation of the patient, a bulging out of the left ventricular apex with a hypercontractile base of the left ventricle is often noted. It is the hallmark bulging-out of the apex of the heart with preserved function of the base that earned the syndrome its name 2547:

Bybee KA, Motiei A, Syed IS, Kara T, Prasad A, Lennon RJ, Murphy JG, Hammill SC, Rihal CS, Wright RS (2006). "Electrocardiography cannot reliably differentiate transient left ventricular apical ballooning syndrome from anterior ST-segment elevation myocardial infarction".

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from extreme stress or a tumor secreting these chemicals is thought to play a central role. Excess catecholamines, when released directly by nerves that stimulate cardiac muscle cells, have a toxic effect and can lead to decreased cardiac muscular function or

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Although the symptoms of takotsubo cardiomyopathy usually go away on their own and the condition completely resolves itself within a few weeks, some serious short and long-term complications can happen that must be treated. These most commonly include

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degeneration similar to animal stress studies. In the end, they concluded their data supported "the theory of catecholamine mediation of these myocardial changes in man and of the lethal potential of stress through its effect on the heart".

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Eitel, Ingo; Knobelsdorff-Brenkenhoff, Florian von; Bernhardt, Peter; Carbone, Iacopo; Muellerleile, Kai; Aldrovandi, Annachiara; Francone, Marco; Desch, Steffen; Gutberlet, Matthias; Strohm, Oliver; Schuler, Gerhard (20 July 2011).

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held hypothesis supporting the idea of the interaction between environmental factors and the interplay of genetic predisposition leading to the susceptibility to microvascular alterations that contribute to the TTS disease process.

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slightly more frequent during the winter season. This may be related to two possible/suspected pathophysiological causes: coronary spasms of microvessels, which are more prevalent in cold weather, and viral infections – such as

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Although the first scientific description of takotsubo cardiomyopathy was not until the 1990s, Cebelin and Hirsch wrote about human stress cardiomyopathy in 1980. The two looked at homicidal assaults that had happened in

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Ghadri, Jelena-Rima; Wittstein, Ilan Shor; Prasad, Abhiram; Sharkey, Scott; Dote, Keigo; Akashi, Yoshihiro John; Cammann, Victoria Lucia; Crea, Filippo; Galiuto, Leonarda; Desmet, Walter; Yoshida, Tetsuro (29 May 2018).

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Several well regarded institutions of medical research have produced clinical criteria useful in diagnosing TTS. One of the first sets of guidelines was initially published in 2004 and again in 2008 by the

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causes of heart troubles; the levels of cardiac enzymes in the heart must be elevated or irregular; and the patient must recover complete contraction and be functioning normally in a short amount of time.

615: 194:(ACS), but that patients with acute complications may co-occur with TTS. These cases of shock and death have been associated with the occurrence of TTS secondary to an inciting physical stressor such as 174:, spontaneously resolving over the course of days to weeks, contemporary observations show that "a subset of TTS patients may present with symptoms arising from its complications, e.g. heart failure, 2007:

Alessandro; Uribarri, Aitor; Thiele, Holger; Brunetti, Natale Daniele; Eitel, Ingo; Stiermaier, Thomas; Hamdani, Nazha; Abumayyaleh, Mohammad; Akin, Ibrahim; El-Battrawy, Ibrahim (April 2024).

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Women, specifically postmenopausal women, are at greatest risk of developing TTS. This has led some researchers to theorize about the possible protective effects of estrogen in preventing TTS.

484:. It classically mimics ST-segment elevation myocardial infarction, and is characterised by acute onset of transient ventricular apical wall motion abnormalities (ballooning) accompanied by 2199:

Kurisu S, Sato H, Kawagoe T, et al. (2002). "Tako-tsubo-like left ventricular dysfunction with ST-segment elevation: a novel cardiac syndrome mimicking acute myocardial infarction".

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Shimizu M, Kato Y, Masai H, Shima T, Miwa Y (August 2006). "Recurrent episodes of takotsubo-like transient left ventricular ballooning occurring in different regions: a case report".

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Aweimer, A; El-Battrawy, I.; Akin, I.; Borggrefe, M.; Mügge, A.; Patsalis, P. C.; Urban, A.; Kummer, M.; Vasileva, S.; Stachon, A.; Hering, S.; Dietrich, J. W. (12 November 2020).

4341: 688:, are considered mainstays of heart failure treatment. But use of beta blockers specifically for takotsubo cardiomyopathy is controversial, because they may confer no benefit. 2512:

Azzarelli S, Galassi AR, Amico F, Giacoppo M, Argentino V, Tomasello SD, Tamburino C, Fiscella A (2006). "Clinical features of transient left ventricular apical ballooning".

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Elesber, A. A.; Prasad, A.; Lennon, R. J.; Wright, R. S.; Lerman, A.; Rihal, C. S. (July 2007). "Four-Year Recurrence Rate and Prognosis of the Apical Ballooning Syndrome".

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in October 2021 found a steady annual increase in takotsubo cardiomyopathy among both women and men from 2006 to 2017, with the sharpest increases among women 50 and older.

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Betts, J Gordon; Desaix, Peter; Johnson, Eddie; Johnson, Jody E; Korol, Oksana; Kruse, Dean; Poe, Brandon; Wise, James; Womble, Mark D; Young, Kelly A (29 July 2023).

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wall motion abnormalities, in which the base of the left ventricle is contracting normally or is hyperkinetic while the remainder of the left ventricle is akinetic or

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Mariani, Silvia; Richter, Jannik; Pappalardo, Federico; Bělohlávek, Jan; Lorusso, Roberto; Schmitto, Jan D.; Bauersachs, Johann; Napp, L. Christian (1 October 2020).

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Templin, C.; Ghadri, J; Diekmann, J.; Napp, C.; Bataiosu, D.; Jaguszewski, M.; Cammann, V.; Sarcon, A.; Geyer, V.; Neuman, C.; Seifert, B.; Hellermann, J. (2015).

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Medina de Chazal, Horacio; Del Buono, Marco Giuseppe; Keyser-Marcus, Lori; Ma, Liangsuo; Moeller, F. Gerard; Berrocal, Daniel; Abbate, Antonio (16 October 2018).

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are examples of physical stressors. In a few cases, the stress may be a happy event, such as a wedding, winning a jackpot, a sporting triumph, or a birthday.

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Hurst RT, Askew JW, Reuss CS, Lee RW, Sweeney JP, Fortuin FD, Oh JK, Tajik AJ (August 2006). "Transient midventricular ballooning syndrome: a new variant".

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Scudiero, F.; Arcari, L.; Silverio, A.; Citro, R.; Bossone, E.; Autore, C.; Muraca, I.; Chinati, P.; Sanna, G.; Piti, A.; Parodi, G. (25 November 2020).

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Transient apical ballooning syndrome, apical ballooning cardiomyopathy, stress-induced cardiomyopathy, broken-heart syndrome, Gebrochenes-Herz syndrome

222: 3672: 2474: 4399: 793:, the past 30 years, specifically those with autopsies who had no internal injury, but had died of physical assault. They found that 11 of 15 had 1282:"Are Neurogenic Stress Cardiomyopathy and Takotsubo Different Syndromes With Common Pathways?: Etiopathological Insights on Dysfunctional Hearts" 1934:"Abnormal thyroid function is common in takotsubo syndrome and depends on two distinct mechanisms: results of a multicentre observational study" 3716: 1351: 582:

showing dilatation of the left ventricle in the acute phase (B) Resolution of left ventricular function on repeat echocardiogram six days later

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Yasu T, Tone K, Kubo N, Saito M (June 2006). "Transient mid-ventricular ballooning cardiomyopathy: a new entity of Takotsubo cardiomyopathy".

100:. It usually appears after a significant stressor, either physical or emotional; when caused by the latter, the condition is sometimes called 1540: 966: 2586:

Pilgrim TM, Wyss TR (March 2008). "Takotsubo cardiomyopathy or transient left ventricular apical ballooning syndrome: A systematic review".

1061:"International Expert Consensus Document on Takotsubo Syndrome (Part I): Clinical Characteristics, Diagnostic Criteria, and Pathophysiology" 4394: 4203: 4040: 993: 1440: 920:

Bergman BR, Reynolds HR, Skolnick AH, Castillo D (August 2008). "A case of apical ballooning cardiomyopathy associated with duloxetine".

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dysfunction. Provided that the individual survives their initial presentation, the left ventricular function improves within two months.

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Left ventriculography during systole showing apical ballooning akinesis with basal hyperkinesis in a characteristic takotsubo ventricle

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Cebelin, Hirsch (1980). "Human stress cardiomyopathy. Myocardial lesions in victims of homicidal assaults without internal injuries".

2802: 1118:"Initial clinical presentation of Takotsubo cardiomyopathy with-a focus on electrocardiographic changes: A literature review of cases" 765:

older than 50 years. About 2.2% of TTS cases had the reversed (basal) variant. Recurrence rate of TTS is about 1.8% per-patient year.

681: 4376: 496:. Cardiac enzymes are usually negative and are moderate at worst, and cardiac catheterization usually shows absence of significant 983: 883:"Transient apical ballooning syndrome—clinical characteristics, ballooning pattern, and long-term follow-up in a Swiss population" 530:

for any other segmental left ventricular ballooning with clinical characteristics of takotsubo-like left ventricular dysfunction.

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Rees, et al. wrote in 1967 that the death of a close relative increases the risk of dying within one year by a factor of seven.

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Akashi YJ, Nakazawa K, Sakakibara M, Miyake F, Koike H, Sasaka K (2003). "The clinical features of takotsubo cardiomyopathy".

2009:"Takotsubo syndrome outcomes predicted by thyroid hormone signature: insights from cluster analysis of a multicentre registry" 4316: 4311: 4235: 882: 447: 4035: 2946:"Cardiomyopathy, Takotsubo Syndrome (Transient Apical Ballooning, Stress-Induced Cardiomyopathy, Gebrochenes-Herz Syndrome)" 4662: 4538: 4467: 4299: 243: 4657: 4450: 4433: 4366: 4286: 3665: 4500: 3008: 438:. Other research institutions proposing diagnostic criteria include the Japanese Takotsubo Cardiomyopathy Study Group, 3945: 3479: 709: 234:

The typical presentation of takotsubo cardiomyopathy is chest pain with or without shortness of breath and associated

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displaying the characteristic apical ballooning with apical motionlessness in a patient with takotsubo cardiomyopathy

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Transient apical ballooning syndrome or takotsubo cardiomyopathy is found in 1.7–2.2% of patients presenting with

4560: 4225: 4152: 3879: 732: 697: 4510: 4684: 4440: 4230: 4127: 4108: 3938: 3711: 3598: 745: 649: 559: 466: 439: 156: 1181:"Clinical Characteristics and Cardiovascular Magnetic Resonance Findings in Stress (Takotsubo) Cardiomyopathy" 4760: 4755: 4717: 4691: 4679: 4667: 4652: 4386: 4328: 4132: 4113: 3765: 3705: 3658: 2048:

Veillet-Chowdhury, M.; Hassan, S. F.; Stergiopoulos, K. (March 2014). "Takotsubo cardiomyopathy: a review".

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Engel, George L. (1971). "Sudden and Rapid Death During Psychological Stress: Folklore or Folk Wisdom?".

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Takotsubo cardiomyopathy occurs worldwide. The condition is thought to be responsible for 2% of all

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It occurs more commonly in postmenopausal women. The name "takotsubo" comes from the Japanese word

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Akashi, Yoshihiro J.; Goldstein, David S.; Barbaro, Giuseppe; Ueyama, Takashi (16 December 2008).

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Eshtehardi P, Koestner SC, Adorjan P, Windecker S, Meier B, Hess OM, Wahl A, Cook S (July 2009).

753: 665: 653: 563: 462: 199: 2797:. Papadakis, Maxine A., McPhee, Stephen J., Rabow, Michael W. (Fifty-sixth ed.). New York. 3521: 1232: 341:

function and stress cardiomyopathy is marked by a dual phenotype, where both impending primary

4734: 4585: 4543: 4458: 4276: 4174: 3891: 3834: 3732: 3609: 3533: 3429: 3394: 3359: 3324: 3275: 3257: 3198: 3180: 3133: 3125: 3106:"Mechanical circulatory support for Takotsubo syndrome: a systematic review and meta-analysis" 3056: 2990: 2955: 2900: 2859: 2808: 2798: 2744: 2703: 2668: 2633: 2603: 2565: 2529: 2494: 2452: 2401: 2360: 2319: 2255: 2216: 2181: 2130: 2112: 2065: 1955: 1911: 1862: 1811: 1747: 1709: 1639: 1593: 1521: 1473: 1465: 1384: 1303: 1255: 1210: 1202: 1157: 1139: 1098: 1080: 989: 962: 937: 902: 822: 717: 595: 477: 235: 183: 65: 2973:

Derrick, Dawn (2009). "The 'Broken Heart Syndrome': Understanding Takotsubo Cardiomyopathy".

1975:"Hyperthyroidism in Takotsubo syndrome: prevalence, clinical features and long-term outcomes" 728:) may be used, but with the consideration that takotsubo is caused by excess catecholamines. 4707: 4599: 4492: 4188: 3493: 3453: 3421: 3386: 3351: 3314: 3306: 3265: 3247: 3188: 3172: 3117: 3046: 2982: 2890: 2851: 2734: 2695: 2660: 2595: 2557: 2521: 2486: 2442: 2434: 2425: 2391: 2350: 2309: 2301: 2247: 2208: 2171: 2161: 2120: 2104: 2057: 2028: 2020: 1986: 1945: 1901: 1893: 1852: 1842: 1801: 1791: 1739: 1699: 1691: 1629: 1583: 1513: 1455: 1374: 1366: 1293: 1247: 1194: 1180: 1147: 1129: 1088: 1072: 933: 929: 894: 847: 817: 773: 725: 701: 661: 579: 330: 144: 120: 4729: 4121: 4102: 4089: 3896: 3775: 3638: 1439:

Pelliccia, Francesco; Kaski, Juan Carlos; Crea, Filippo; Camici, Paolo G. (13 June 2017).

350: 342: 175: 1831:"Cardiovascular Manifestations and Complications of Pheochromocytomas and Paragangliomas" 2033: 2008: 417:

A 2019 case involved a 60-year-old woman presenting with TTS due to over-consumption of

4722: 4630: 4528: 4520: 4418: 3928: 3921: 3908: 3592: 3319: 3294: 3270: 3235: 3193: 3160: 2739: 2722: 2561: 2447: 2421:"Takotsubo Cardiomyopathy Triggered by Wasabi Consumption: Can Sushi Break Your Heart?" 2420: 2314: 2289: 2176: 2149: 2125: 2092: 1906: 1881: 1857: 1830: 1806: 1779: 1704: 1679: 1617: 1152: 1117: 1093: 1060: 657: 470: 394: 367: 334: 297: 213:"octopus trap", because the left ventricle of the heart takes on a shape resembling an 187: 160: 147:, thereby raising blood pressure and placing more stress on the heart, and may lead to 135: 93: 3497: 3390: 3176: 2355: 2338: 2251: 1634: 1517: 1460: 446:, the Takotsubo Italian Network and the Heart Failure Associates TTS Taskforce of the 4749: 4712: 4623: 3758: 3145: 1663: 1485: 1009: 713: 677: 504: 127: 3505: 1396: 4644: 4618: 4462: 4410: 4083: 4059: 4029: 4006: 3875: 3865: 2077: 685: 363: 270: 261:

with a spouse, relationship disagreements, betrayal, and financial problems. Acute

214: 190:". This does not imply that rates of shock/death of TTS are comparable to those of 2525: 2380:"Tako-Tsubo cardiomyopathy: insights into the possible underlying pathophysiology" 1280:

Tavazzi, G.; Zanierato, M.; Via, G.; Iotti, G. A.; Procaccio, F. (December 2017).

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The diagnosis of takotsubo cardiomyopathy may be difficult upon presentation. The

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stress. Some patients have a preceding clinical stressor (such as a brain injury,

17: 3650: 3603: 3448: 3121: 2699: 2599: 2490: 2339:"Assessment of clinical features in transient left ventricular apical ballooning" 2061: 1991: 1974: 1010:"Mayo Clinic Research Reveals 'Broken Heart Syndrome' Recurs in 1 of 10 Patients" 898: 526:

for mid-ventricular ballooning accompanied by basal and apical hyperkinesia, and

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have been identified as potential risk factors for TTS. The relationship between

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that supply blood to the heart muscle. This impairs the arteries from delivering

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McPhee, Stephen J.; Rabow, Michael W.; Papadakis, Maxine A. (1 September 2016).

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The syndrome reached international audiences through the media in 2005 when the

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currently no internationally agreed protocol for treatment of this condition.

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Schematic representation of cardiomyopathy (A) compared to a normal heart (B)

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is necessary to determine proper management. For those with obstructed LVOTs

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artery, which will not reveal any significant blockages that would cause the

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agents should not be used, but instead should be managed like patients with

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cases presenting to hospitals. Although TTS has generally been considered a

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For people with cardiogenic shock, medical treatment is based on whether a

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findings often are confused with those found during an acute anterior wall

3398: 3363: 3328: 3310: 1796: 1251: 1198: 1134: 720:). For cases in which the LVOT is not obstructed, inotropic therapy (e.g. 126:

The pathophysiology is not well understood, but a sudden massive surge of

4533: 3690: 3161:"Takotsubo Cardiomyopathy: A New Form of Acute, Reversible Heart Failure" 2290:"Apical ballooning of the left ventricle: first series in white patients" 1778:

Komamura, K.; Fukui, M.; Iwasaku, T.; Hirotani, S.; Masuyama, T. (2014).

1504:

Akashi YJ, Nef HM, Möllmann H, Ueyama T (2010). "Stress cardiomyopathy".

705: 451: 366:) and the effects these chemicals have on areas of the heart, especially 152: 90: 2337:

Abe Y, Kondo M, Matsuoka R, Araki M, Dohyama K, Tanio H (5 March 2003).

2166: 492:, ST-segment elevation, T-wave inversion or QT-interval prolongation on 3217: 2986: 2895: 2878: 1950: 1933: 1847: 636: 489: 422: 338: 3560: 2378:

Merli, E.; Sutcliffe, S.; Gori, M.; Sutherland, G. G. (January 2006).

837:

refers to the intense emotional stress that may provoke this syndrome.

4613: 4593: 3748: 3572: 3547:- website for professionals and people who have experienced Takotsubo 2723:"Takotsubo cardiomyopathy or broken heart syndrome: A review article" 1233:"Clinical features and outcomes of takotsubo (stress) cardiomyopathy" 603: 418: 292: 274: 262: 179: 108: 2150:"Stress-induced cardiomyopathy (Takotsubo) – broken heart and mind?" 1780:"Takotsubo cardiomyopathy: Pathophysiology, diagnosis and treatment" 389:

It has been suggested that the response to catecholamines (such as

2475:"Diagnostic criteria for takotsubo syndrome: A call for consensus" 772: 254: 2232: 2230: 1185: 203: 3654: 3480:"Understanding Heartbreak: From Takotsubo to Wuthering Heights" 3080:"Management and prognosis of stress (takotsubo) cardiomyopathy" 2879:"'Tako-Tsubo' transient ventricular dysfunction: a case report" 1541:"'Broken heart syndrome' on the rise, increasingly among women" 2842: 493: 606:

changes from a person with confirmed takotsubo cardiomyopathy

514:

The ballooning patterns were classified by Shimizu et al. as

777:

The Japanese octopus traps after which this disease is named

2283: 2281: 143:". Further, this adrenaline surge triggers the arteries to 3236:"Reverse Takotsubo cardiomyopathy: a comprehensive review" 2877:

Nyui N, Yamanaka O, Nakayama R, Sawano M, Kawai S (2000).

731:

Furthermore, mechanical circulatory support (MCS) with an

3544: 3478:

Krishnan, Lakshmi; Marchalik, Daniel (8 September 2018).

3234:

Awad, Hamza H.; McNeal, Ashley R.; Goyal, Hemant (2018).

2238:

Pectoris-Myocardial Infarction Investigations in Japan".

1659:"Shock of good news can hurt your heart as much as grief" 2271: 2269: 1352:"Epidemiology and pathophysiology of Takotsubo syndrome" 155:

to the heart muscle. Together, these events can lead to

1611: 1609: 1607: 2473:

Redfors, B.; Shao, Y.; Lyon, A.; Omerovic, E. (2014).

2419:

Finkel-Oron, A.; Olchowski, J.; Jotkowitz, A. (2019).

2288:

Desmet WJ, Adriaenssens BF, Dens JA (September 2003).

1725: 1723: 107:

Examples of physical stressors that can cause TTS are

96:

in which there is a sudden temporary weakening of the

1880:

Kalra, S; Lakhani, OJ; Chaudhary, S. (October 2020).

3550: 1350:

Akashi, Y. J.; Nef, H. M.; Lyon, A. R. (July 2015).

988:. Springer Science and Business Media. p. 387. 735:(IABP) is well-established as supportive treatment. 4700: 4643: 4552: 4519: 4491: 4449: 4408: 4385: 4359: 4327: 4285: 4266: 4165: 4151: 4051: 4005: 3991: 3907: 3856: 3849: 3786: 3741: 3698: 3689: 3624: 3554: 64: 42: 37: 1568:Gianni M, Dentali F, et al. (December 2006). 961:. Houston: OpenStax CNX. 19.4 Cardiac Physiology. 3412:Wittstein I (2007). "The broken heart syndrome". 3035:"Clinical management of takotsubo cardiomyopathy" 1434: 1432: 1430: 1428: 1426: 1116:Sanchez-Jimenez, Erick Francisco (26 July 2013). 624:Echocardiogram showing the effects of the disease 383:introduced, the result is acute cardiac ischemia. 300:– which occur more frequently during the winter. 1424: 1422: 1420: 1418: 1416: 1414: 1412: 1410: 1408: 1406: 700:(LVOT) obstruction is present. Therefore, early 3449:"'House' Reality Check: Broken Heart Syndrome?" 2954:. Treasure Island (FL): StatPearls Publishing. 2619: 2617: 2581: 2579: 1927: 1925: 1499: 1497: 1495: 826:, firefighter Derek suffers from this syndrome. 2795:Current medical diagnosis & treatment 2017 1345: 1343: 1341: 1339: 1337: 1275: 1273: 1271: 1269: 876: 874: 872: 870: 868: 866: 864: 862: 375:Microvascular dysfunction/Transient vasospasm: 27:Sudden temporary weakening of the heart muscle 3666: 3028: 3026: 2653:Journal of the American College of Cardiology 2343:Journal of the American College of Cardiology 2240:Journal of the American College of Cardiology 2097:Journal of the American College of Cardiology 1732:Journal of the American College of Cardiology 1335: 1333: 1331: 1329: 1327: 1325: 1323: 1321: 1319: 1317: 406:Mid-ventricular obstruction, apical stunning: 8: 3229: 3227: 3225: 2148:Redfors, B.; Shao, Y.; Omerovic, E. (2013). 1829:Y-Hassan, S.; Falhammar, H. (30 July 2020). 522:for basal akinesia and apical hyperkinesia, 518:for apical akinesia and basal hyperkinesia, 3011:. National Heart, Lung, and Blood Institute 1616:Sharkey, S.; Lesser, J.; Maron, B. (2011). 829:The name and title track of the 2021 album 820:("Words and Deeds", 2007) of the TV series 4282: 4162: 4002: 3983:Arrhythmogenic right ventricular dysplasia 3853: 3695: 3673: 3659: 3651: 3551: 2825:: CS1 maint: location missing publisher ( 1628:(18). American Heart Association: e460-2. 51: 34: 3318: 3269: 3251: 3192: 3050: 2894: 2738: 2446: 2395: 2354: 2313: 2175: 2165: 2124: 2032: 1990: 1949: 1905: 1856: 1846: 1805: 1795: 1703: 1678:Jelena Ghadri; et al. (March 2016). 1633: 1587: 1563: 1561: 1459: 1378: 1297: 1151: 1133: 1092: 223:Journal of the American Heart Association 2727:Journal of Research in Medical Sciences 2721:Golabchi, A; Sarrafzadegan, N. (2011). 1441:"Pathophysiology of Takotsubo Syndrome" 934:10.7326/0003-4819-149-3-200808050-00021 858: 536: 3717:Spontaneous coronary artery dissection 2818: 2763:"UOTW No. 74 - Ultrasound of the Week" 3074: 3072: 3070: 2788: 2786: 2784: 2468: 2466: 1773: 1771: 1769: 1767: 1765: 1763: 1761: 1053: 1051: 1049: 1047: 1045: 1043: 676:For patients in acute heart failure, 387:Catecholamine-induced myocyte injury: 7: 4041:Nonbacterial thrombotic endocarditis 3414:Cleveland Clinic Journal of Medicine 3218:https://doi.org/10.2147/TCRM.S131760 2384:European Journal of Echocardiography 1539:Thor Christensen (13 October 2021). 1226: 1224: 1173: 1171: 1041: 1039: 1037: 1035: 1033: 1031: 1029: 1027: 1025: 1023: 3246:(23). AME Publishing Company: 460. 3110:International Journal of Cardiology 2944:Shah, Sandy; Bhimji, Steve (2017). 2688:International Journal of Cardiology 2588:International Journal of Cardiology 2479:International Journal of Cardiology 2154:Vascular Health and Risk Management 1618:"Takotsubo (stress) cardiomyopathy" 887:International Journal of Cardiology 660:in the apex of the left ventricle, 4337:Accelerated idioventricular rhythm 3216:Clinical Risk Management, 13–863. 2919:"Medics 'can mend a broken heart'" 2562:10.1016/j.jelectrocard.2006.04.007 985:The Physics of Coronary Blood Flow 25: 3522:"Death by voodoo: truth or tale?" 3177:10.1161/CIRCULATIONAHA.108.767012 1635:10.1161/CIRCULATIONAHA.111.052662 1518:10.1146/annurev.med.041908.191750 1461:10.1161/CIRCULATIONAHA.116.027121 217:when affected by this condition. 3240:Annals of Translational Medicine 1016:. MediLexicon International Ltd. 611: 587: 571: 551: 539: 257:, where it was first described. 4022:Subacute bacterial endocarditis 3520:Wagner, Judith N. (Fall 2014). 3447:Wired Staff (10 January 2007). 3033:Kurisu, S.; Kihara, Y. (2014). 1657:Coghlan, Andy (12 March 2016). 1545:American Heart Association News 1240:New England Journal of Medicine 804:New England Journal of Medicine 2514:American Journal of Cardiology 1985:(Supplement_2): ehaa946.1812. 698:left ventricular outflow tract 448:European Society of Cardiology 153:adequate blood flow and oxygen 149:spasm of the coronary arteries 1: 4539:Pulseless electrical activity 4468:Multifocal atrial tachycardia 4342:Catecholaminergic polymorphic 3526:Hektoen International Journal 3498:10.1016/S0140-6736(18)32061-0 3391:10.1016/s0046-8177(80)80129-8 2526:10.1016/j.amjcard.2006.05.065 2356:10.1016/S0735-1097(02)02925-X 2252:10.1016/S0735-1097(01)01316-X 682:angiotensin receptor blockers 503:The diagnosis is made by the 465:to rule out occlusion of the 98:muscular portion of the heart 3293:Rees WD, Lutkins SG (1967). 3122:10.1016/j.ijcard.2020.05.033 2883:Japanese Circulation Journal 2700:10.1016/j.ijcard.2005.05.060 2600:10.1016/j.ijcard.2007.07.002 2491:10.1016/j.ijcard.2014.06.094 2062:10.3109/17482941.2013.869346 1938:Journal of Internal Medicine 1835:Journal of Clinical Medicine 899:10.1016/j.ijcard.2008.03.088 656:, and less commonly include 163:of blood with each squeeze. 3426:10.3949/ccjm.74.Suppl_1.S17 3344:Annals of Internal Medicine 2025:10.1016/j.ebiom.2024.105063 1784:World Journal of Cardiology 1122:World Journal of Cardiology 922:Annals of Internal Medicine 710:hypertrophic cardiomyopathy 4777: 4483:Wandering atrial pacemaker 4030:non-infective endocarditis 3971:Endocardial fibroelastosis 3356:10.7326/0003-4819-74-5-771 3295:"Mortality of Bereavement" 2665:10.1016/j.jacc.2006.06.015 2397:10.1016/j.euje.2005.08.003 2109:10.1016/j.jacc.2018.07.072 1992:10.1093/ehjci/ehaa946.1812 1882:"Takotsubo Endocrinopathy" 1744:10.1016/j.jacc.2007.03.050 1299:10.1016/j.jchf.2017.09.006 807:wrote about the syndrome. 238:(ECG) changes mimicking a 4561:hexaxial reference system 4506:Jervell and Lange-Nielsen 4036:Libman–Sacks endocarditis 1506:Annual Review of Medicine 1359:Nature Reviews Cardiology 754:rupture of the heart wall 733:intra-aortic balloon pump 666:tearing of the heart wall 220:A study published in the 59: 50: 4441:Ventricular fibrillation 3712:Coronary artery aneurysm 3052:10.1253/circj.cj-14-0382 1898:10.17925/EE.2020.16.2.97 1696:10.1093/eurheartj/ehv757 1589:10.1093/eurheartj/ehl032 1371:10.1038/nrcardio.2015.39 1077:10.1093/eurheartj/ehy076 958:Anatomy & Physiology 746:congestive heart failure 650:congestive heart failure 467:left anterior descending 444:Johns Hopkins University 345:and a high set point of 157:congestive heart failure 79:Takotsubo cardiomyopathy 38:Takotsubo cardiomyopathy 4718:Diastolic heart failure 4692:Athletic heart syndrome 4653:Ventricular hypertrophy 4387:Pre-excitation syndrome 4241:Left posterior fascicle 3766:Acute coronary syndrome 3706:Coronary artery disease 3299:British Medical Journal 3253:10.21037/atm.2018.11.08 3009:"Broken Heart Syndrome" 2439:10.1136/bcr-2019-230065 2306:10.1136/heart.89.9.1027 2213:10.1067/mhj.2002.120403 498:coronary artery disease 459:acute coronary syndrome 267:subarachnoid hemorrhage 198:, brain injury sepsis, 192:acute coronary syndrome 168:acute coronary syndrome 117:subarachnoid hemorrhage 4236:Left anterior fascicle 4016:infective endocarditis 3801:Hibernating myocardium 3682:Cardiovascular disease 2767:Ultrasound of the Week 2275:Kawai et al. JPJ 2000. 2201:American Heart Journal 1979:European Heart Journal 1886:European Endocrinology 1684:European Heart Journal 1575:European Heart Journal 1065:European Heart Journal 778: 750:abnormal heart rhythms 321:Hormonal dysregulation 4400:Wolff–Parkinson–White 4360:Premature contraction 4258:Adams–Stokes syndrome 3961:Loeffler endocarditis 3771:Myocardial infarction 3311:10.1136/bmj.4.5570.13 2626:Journal of Cardiology 1797:10.4330/wjc.v6.i7.602 1252:10.1056/NEJMoa1406761 1199:10.1001/jama.2011.992 1135:10.4330/wjc.v5.i7.228 791:Cuyahoga County, Ohio 776: 482:myocardial infarction 440:Gothenburg University 240:myocardial infarction 172:self-limiting disease 102:broken heart syndrome 87:stress cardiomyopathy 85:(TTS), also known as 4567:Right axis deviation 4529:Sudden cardiac death 3887:Pericardial effusion 3830:Ventricular aneurysm 2856:10.1093/qjmed/hcg096 818:episode 11, Season 3 662:irregular heart beat 524:mid-ventricular type 312:Genetic risk factors 4572:Left axis deviation 4429:Atrial fibrillation 4424:Ventricular flutter 4347:Torsades de pointes 4221:Bundle branch block 4180:Sick sinus syndrome 3966:Cardiac amyloidosis 3951:Tachycardia-induced 3806:Myocardial stunning 3754:Prinzmetal's angina 3723:Coronary thrombosis 3039:Circulation Journal 2975:Critical Care Nurse 2769:. 20 September 2016 2167:10.2147/VHRM.S40163 718:fluid resuscitation 490:shortness of breath 421:, mistaking it for 399:sympathetic nervous 347:thyroid homeostasis 329:diseases including 89:, is a type of non- 4675:Atrial enlargement 4473:Pacemaker syndrome 4395:Lown–Ganong–Levine 4317:Junctional ectopic 4312:AV nodal reentrant 3818:Myocardial rupture 3728:Coronary vasospasm 3625:External resources 2987:10.4037/ccn2009451 2896:10.1253/jcj.64.715 2050:Acute Cardiac Care 1951:10.1111/joim.13189 1848:10.3390/jcm9082435 1286:JACC Heart Failure 1014:Medical News Today 982:Zamir, M. (2005). 811:In popular culture 779: 692:Low blood pressure 654:low blood pressure 463:coronary angiogram 230:Signs and symptoms 200:pulmonary embolism 83:takotsubo syndrome 18:Takotsubo syndrome 4743: 4742: 4735:Obstructive shock 4639: 4638: 4586:Short QT syndrome 4553:Other / ungrouped 4544:Sinoatrial arrest 4459:Ectopic pacemaker 4355: 4354: 4175:Sinus bradycardia 4147: 4146: 4143: 4142: 3892:Cardiac tamponade 3845: 3844: 3835:Dressler syndrome 3733:Myocardial bridge 3648: 3647: 3545:Takotsubo Network 3171:(25): 2754–2762. 2103:(16): 1955–1971. 1690:(37): 2823–2829. 1582:(13): 1523–1529. 1454:(24): 2426–2441. 1071:(22): 2032–2046. 968:978-1-947172-04-3 619: 598:and non-specific 596:sinus tachycardia 520:reverse takotsubo 349:(encoding type 2 236:electrocardiogram 184:cardiogenic shock 159:and decrease the 76: 75: 32:Medical condition 16:(Redirected from 4768: 4708:Cardiac fibrosis 4600:T wave alternans 4493:Long QT syndrome 4287:Supraventricular 4283: 4216:Intraventricular 4163: 4003: 3854: 3699:Coronary disease 3696: 3675: 3668: 3661: 3652: 3552: 3541: 3516: 3514: 3512: 3466: 3465: 3463: 3461: 3444: 3438: 3437: 3409: 3403: 3402: 3374: 3368: 3367: 3339: 3333: 3332: 3322: 3290: 3284: 3283: 3273: 3255: 3231: 3220: 3213: 3207: 3206: 3196: 3156: 3150: 3149: 3101: 3095: 3094: 3092: 3090: 3084:www.uptodate.com 3076: 3065: 3064: 3054: 3045:(7): 1559–1566. 3030: 3021: 3020: 3018: 3016: 3005: 2999: 2998: 2970: 2964: 2963: 2941: 2935: 2934: 2932: 2930: 2915: 2909: 2908: 2898: 2874: 2868: 2867: 2837: 2831: 2830: 2824: 2816: 2790: 2779: 2778: 2776: 2774: 2759: 2753: 2752: 2742: 2718: 2712: 2711: 2683: 2677: 2676: 2648: 2642: 2641: 2621: 2612: 2611: 2583: 2574: 2573: 2550:J Electrocardiol 2544: 2538: 2537: 2520:(9): 1273–1276. 2509: 2503: 2502: 2470: 2461: 2460: 2450: 2426:BMJ Case Reports 2416: 2410: 2409: 2399: 2375: 2369: 2368: 2358: 2334: 2328: 2327: 2317: 2300:(9): 1027–1031. 2285: 2276: 2273: 2264: 2263: 2234: 2225: 2224: 2196: 2190: 2189: 2179: 2169: 2145: 2139: 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3841: 3782: 3776:Unstable angina 3749:Angina pectoris 3742:Active ischemia 3737: 3685: 3679: 3649: 3644: 3643: 3639:article/1513631 3620: 3619: 3563: 3519: 3510: 3508: 3477: 3474: 3469: 3459: 3457: 3446: 3445: 3441: 3411: 3410: 3406: 3379:Human Pathology 3376: 3375: 3371: 3341: 3340: 3336: 3305:(5570): 13–16. 3292: 3291: 3287: 3233: 3232: 3223: 3214: 3210: 3158: 3157: 3153: 3103: 3102: 3098: 3088: 3086: 3078: 3077: 3068: 3032: 3031: 3024: 3014: 3012: 3007: 3006: 3002: 2972: 2971: 2967: 2943: 2942: 2938: 2928: 2926: 2925:. 27 March 2009 2917: 2916: 2912: 2876: 2875: 2871: 2839: 2838: 2834: 2817: 2805: 2792: 2791: 2782: 2772: 2770: 2761: 2760: 2756: 2720: 2719: 2715: 2685: 2684: 2680: 2650: 2649: 2645: 2623: 2622: 2615: 2585: 2584: 2577: 2546: 2545: 2541: 2511: 2510: 2506: 2472: 2471: 2464: 2418: 2417: 2413: 2377: 2376: 2372: 2336: 2335: 2331: 2287: 2286: 2279: 2274: 2267: 2236: 2235: 2228: 2198: 2197: 2193: 2147: 2146: 2142: 2090: 2089: 2085: 2047: 2046: 2042: 2005: 2004: 2000: 1972: 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4649: 4647: 4641: 4640: 4637: 4636: 4634: 4633: 4631:Strain pattern 4628: 4627: 4626: 4621: 4616: 4604: 4603: 4602: 4590: 4589: 4588: 4576: 4575: 4574: 4569: 4556: 4554: 4550: 4549: 4547: 4546: 4541: 4536: 4531: 4525: 4523: 4521:Cardiac arrest 4517: 4516: 4514: 4513: 4508: 4503: 4501:Andersen–Tawil 4497: 4495: 4489: 4488: 4486: 4485: 4480: 4475: 4470: 4465: 4455: 4453: 4447: 4446: 4444: 4443: 4438: 4437: 4436: 4426: 4421: 4419:Atrial flutter 4415: 4413: 4406: 4405: 4403: 4402: 4397: 4391: 4389: 4383: 4382: 4380: 4379: 4374: 4369: 4363: 4361: 4357: 4356: 4353: 4352: 4350: 4349: 4344: 4339: 4333: 4331: 4325: 4324: 4322: 4321: 4320: 4319: 4314: 4304: 4303: 4302: 4291: 4289: 4280: 4264: 4263: 4261: 4260: 4255: 4254: 4253: 4248: 4243: 4238: 4233: 4228: 4218: 4213: 4212: 4211: 4206: 4201: 4191: 4182: 4177: 4171: 4169: 4160: 4149: 4148: 4145: 4144: 4141: 4140: 4138: 4137: 4136: 4135: 4130: 4118: 4117: 4116: 4111: 4099: 4098: 4097: 4092: 4080: 4079: 4078: 4073: 4068: 4055: 4053: 4049: 4048: 4046: 4045: 4044: 4043: 4038: 4026: 4025: 4024: 4011: 4009: 4000: 3989: 3988: 3986: 3985: 3980: 3979: 3978: 3973: 3968: 3963: 3958: 3953: 3948: 3943: 3942: 3941: 3929:Cardiomyopathy 3926: 3925: 3924: 3922:Chagas disease 3913: 3911: 3905: 3904: 3902: 3901: 3900: 3899: 3894: 3884: 3883: 3882: 3873: 3862: 3860: 3851: 3847: 3846: 3843: 3842: 3840: 3839: 3838: 3837: 3832: 3822: 3821: 3820: 3810: 3809: 3808: 3803: 3792: 3790: 3784: 3783: 3781: 3780: 3779: 3778: 3773: 3763: 3762: 3761: 3756: 3745: 3743: 3739: 3738: 3736: 3735: 3730: 3725: 3720: 3714: 3709: 3702: 3700: 3693: 3687: 3686: 3680: 3678: 3677: 3670: 3663: 3655: 3646: 3645: 3642: 3641: 3629: 3628: 3626: 3622: 3621: 3618: 3617: 3606: 3595: 3580: 3564: 3559: 3558: 3556: 3555:Classification 3549: 3548: 3542: 3517: 3492:(10150): 812. 3473: 3472:External links 3470: 3468: 3467: 3439: 3420:(1): S17–S22. 3404: 3385:(2): 123–132. 3369: 3350:(5): 771–783. 3334: 3285: 3221: 3208: 3151: 3096: 3066: 3022: 3000: 2965: 2936: 2910: 2889:(9): 715–719. 2869: 2832: 2804:978-1259585111 2803: 2780: 2754: 2733:(3): 340–345. 2713: 2678: 2659:(3): 579–583. 2643: 2613: 2594:(3): 283–292. 2575: 2556:(1): 38.e1–6. 2539: 2504: 2462: 2433:(9): e230065. 2411: 2370: 2349:(5): 737–742. 2329: 2277: 2265: 2226: 2207:(3): 448–455. 2191: 2140: 2083: 2040: 1998: 1965: 1944:(5): 675–687. 1921: 1872: 1821: 1790:(7): 602–609. 1757: 1738:(5): 448–452. 1719: 1670: 1649: 1603: 1557: 1531: 1491: 1402: 1365:(7): 387–397. 1313: 1292:(12): 940–42. 1265: 1220: 1193:(3): 277–286. 1167: 1128:(7): 228–241. 1108: 1019: 1001: 994: 974: 967: 947: 912: 857: 855: 852: 851: 850: 843: 840: 839: 838: 827: 812: 809: 770: 767: 761: 758: 740: 737: 693: 690: 678:ACE inhibitors 673: 670: 658:blood clotting 631: 628: 627: 626: 623: 610: 608: 593: 586: 584: 580:Echocardiogram 577: 570: 568: 560:ventriculogram 557: 550: 548: 545: 538: 528:localised type 516:takotsubo type 430: 427: 411: 410: 403: 395:norepinephrine 384: 368:neuropeptide Y 358: 355: 335:thyrotoxicosis 322: 319: 313: 310: 305: 302: 298:Parvovirus B19 287: 286:Stress trigger 284: 282: 279: 251:"octopus trap" 231: 228: 188:cardiac arrest 161:heart's output 136:norepinephrine 128:catecholamines 94:cardiomyopathy 74: 73: 68: 62: 61: 57: 56: 48: 47: 44: 40: 39: 31: 26: 24: 14: 13: 10: 9: 6: 4: 3: 2: 4773: 4762: 4759: 4757: 4754: 4753: 4751: 4736: 4733: 4731: 4728: 4724: 4721: 4719: 4716: 4715: 4714: 4713:Heart failure 4711: 4709: 4706: 4705: 4703: 4699: 4693: 4690: 4686: 4683: 4681: 4678: 4677: 4676: 4673: 4669: 4666: 4664: 4661: 4659: 4656: 4655: 4654: 4651: 4650: 4648: 4646: 4642: 4632: 4629: 4625: 4624:ST depression 4622: 4620: 4617: 4615: 4612: 4611: 4610: 4609: 4605: 4601: 4598: 4597: 4596: 4595: 4591: 4587: 4584: 4583: 4582: 4581: 4577: 4573: 4570: 4568: 4565: 4564: 4563: 4562: 4558: 4557: 4555: 4551: 4545: 4542: 4540: 4537: 4535: 4532: 4530: 4527: 4526: 4524: 4522: 4518: 4512: 4509: 4507: 4504: 4502: 4499: 4498: 4496: 4494: 4490: 4484: 4481: 4479: 4476: 4474: 4471: 4469: 4466: 4464: 4460: 4457: 4456: 4454: 4452: 4448: 4442: 4439: 4435: 4432: 4431: 4430: 4427: 4425: 4422: 4420: 4417: 4416: 4414: 4412: 4407: 4401: 4398: 4396: 4393: 4392: 4390: 4388: 4384: 4378: 4375: 4373: 4370: 4368: 4365: 4364: 4362: 4358: 4348: 4345: 4343: 4340: 4338: 4335: 4334: 4332: 4330: 4326: 4318: 4315: 4313: 4310: 4309: 4308: 4305: 4301: 4298: 4297: 4296: 4293: 4292: 4290: 4288: 4284: 4281: 4278: 4274: 4269: 4265: 4259: 4256: 4252: 4251:Trifascicular 4249: 4247: 4244: 4242: 4239: 4237: 4234: 4232: 4229: 4227: 4224: 4223: 4222: 4219: 4217: 4214: 4210: 4207: 4205: 4202: 4200: 4197: 4196: 4195: 4192: 4190: 4186: 4183: 4181: 4178: 4176: 4173: 4172: 4170: 4168: 4164: 4161: 4159: 4154: 4150: 4134: 4133:regurgitation 4131: 4129: 4126: 4125: 4124: 4123: 4119: 4115: 4114:regurgitation 4112: 4110: 4107: 4106: 4105: 4104: 4100: 4096: 4095:regurgitation 4093: 4091: 4088: 4087: 4086: 4085: 4081: 4077: 4076:regurgitation 4074: 4072: 4069: 4067: 4064: 4063: 4062: 4061: 4057: 4056: 4054: 4050: 4042: 4039: 4037: 4034: 4033: 4032: 4031: 4027: 4023: 4020: 4019: 4018: 4017: 4013: 4012: 4010: 4008: 4004: 4001: 3999: 3994: 3990: 3984: 3981: 3977: 3974: 3972: 3969: 3967: 3964: 3962: 3959: 3957: 3954: 3952: 3949: 3947: 3944: 3940: 3937: 3936: 3935: 3932: 3931: 3930: 3927: 3923: 3920: 3919: 3918: 3915: 3914: 3912: 3910: 3906: 3898: 3895: 3893: 3890: 3889: 3888: 3885: 3881: 3877: 3874: 3872: 3869: 3868: 3867: 3864: 3863: 3861: 3859: 3855: 3852: 3848: 3836: 3833: 3831: 3828: 3827: 3826: 3823: 3819: 3816: 3815: 3814: 3811: 3807: 3804: 3802: 3799: 3798: 3797: 3794: 3793: 3791: 3789: 3785: 3777: 3774: 3772: 3769: 3768: 3767: 3764: 3760: 3759:Stable angina 3757: 3755: 3752: 3751: 3750: 3747: 3746: 3744: 3740: 3734: 3731: 3729: 3726: 3724: 3721: 3718: 3715: 3713: 3710: 3707: 3704: 3703: 3701: 3697: 3694: 3692: 3688: 3683: 3676: 3671: 3669: 3664: 3662: 3657: 3656: 3653: 3640: 3636: 3635: 3631: 3630: 3627: 3623: 3616: 3612: 3611: 3607: 3605: 3601: 3600: 3596: 3594: 3590: 3589: 3585: 3581: 3579: 3575: 3574: 3570: 3566: 3565: 3562: 3557: 3553: 3546: 3543: 3539: 3535: 3531: 3527: 3523: 3518: 3507: 3503: 3499: 3495: 3491: 3487: 3486: 3481: 3476: 3475: 3471: 3456: 3455: 3450: 3443: 3440: 3435: 3431: 3427: 3423: 3419: 3415: 3408: 3405: 3400: 3396: 3392: 3388: 3384: 3380: 3373: 3370: 3365: 3361: 3357: 3353: 3349: 3345: 3338: 3335: 3330: 3326: 3321: 3316: 3312: 3308: 3304: 3300: 3296: 3289: 3286: 3281: 3277: 3272: 3267: 3263: 3259: 3254: 3249: 3245: 3241: 3237: 3230: 3228: 3226: 3222: 3219: 3212: 3209: 3204: 3200: 3195: 3190: 3186: 3182: 3178: 3174: 3170: 3166: 3162: 3155: 3152: 3147: 3143: 3139: 3135: 3131: 3127: 3123: 3119: 3115: 3111: 3107: 3100: 3097: 3085: 3081: 3075: 3073: 3071: 3067: 3062: 3058: 3053: 3048: 3044: 3040: 3036: 3029: 3027: 3023: 3010: 3004: 3001: 2996: 2992: 2988: 2984: 2980: 2976: 2969: 2966: 2961: 2957: 2953: 2952: 2947: 2940: 2937: 2924: 2920: 2914: 2911: 2906: 2902: 2897: 2892: 2888: 2884: 2880: 2873: 2870: 2865: 2861: 2857: 2853: 2850:(8): 563–73. 2849: 2845: 2844: 2836: 2833: 2828: 2822: 2814: 2810: 2806: 2800: 2796: 2789: 2787: 2785: 2781: 2768: 2764: 2758: 2755: 2750: 2746: 2741: 2736: 2732: 2728: 2724: 2717: 2714: 2709: 2705: 2701: 2697: 2693: 2689: 2682: 2679: 2674: 2670: 2666: 2662: 2658: 2654: 2647: 2644: 2639: 2635: 2631: 2627: 2620: 2618: 2614: 2609: 2605: 2601: 2597: 2593: 2589: 2582: 2580: 2576: 2571: 2567: 2563: 2559: 2555: 2551: 2543: 2540: 2535: 2531: 2527: 2523: 2519: 2515: 2508: 2505: 2500: 2496: 2492: 2488: 2484: 2480: 2476: 2469: 2467: 2463: 2458: 2454: 2449: 2444: 2440: 2436: 2432: 2428: 2427: 2422: 2415: 2412: 2407: 2403: 2398: 2393: 2389: 2385: 2381: 2374: 2371: 2366: 2362: 2357: 2352: 2348: 2344: 2340: 2333: 2330: 2325: 2321: 2316: 2311: 2307: 2303: 2299: 2295: 2291: 2284: 2282: 2278: 2272: 2270: 2266: 2261: 2257: 2253: 2249: 2245: 2241: 2233: 2231: 2227: 2222: 2218: 2214: 2210: 2206: 2202: 2195: 2192: 2187: 2183: 2178: 2173: 2168: 2163: 2159: 2155: 2151: 2144: 2141: 2136: 2132: 2127: 2122: 2118: 2114: 2110: 2106: 2102: 2098: 2094: 2087: 2084: 2079: 2075: 2071: 2067: 2063: 2059: 2055: 2051: 2044: 2041: 2035: 2030: 2026: 2022: 2018: 2014: 2010: 2002: 1999: 1993: 1988: 1984: 1980: 1976: 1969: 1966: 1961: 1957: 1952: 1947: 1943: 1939: 1935: 1928: 1926: 1922: 1917: 1913: 1908: 1903: 1899: 1895: 1891: 1887: 1883: 1876: 1873: 1868: 1864: 1859: 1854: 1849: 1844: 1840: 1836: 1832: 1825: 1822: 1817: 1813: 1808: 1803: 1798: 1793: 1789: 1785: 1781: 1774: 1772: 1770: 1768: 1766: 1764: 1762: 1758: 1753: 1749: 1745: 1741: 1737: 1733: 1726: 1724: 1720: 1715: 1711: 1706: 1701: 1697: 1693: 1689: 1685: 1681: 1674: 1671: 1666: 1665: 1664:New Scientist 1660: 1653: 1650: 1645: 1641: 1636: 1631: 1627: 1623: 1619: 1612: 1610: 1608: 1604: 1599: 1595: 1590: 1585: 1581: 1577: 1576: 1571: 1564: 1562: 1558: 1546: 1542: 1535: 1532: 1527: 1523: 1519: 1515: 1511: 1507: 1500: 1498: 1496: 1492: 1487: 1483: 1479: 1475: 1471: 1467: 1462: 1457: 1453: 1449: 1442: 1435: 1433: 1431: 1429: 1427: 1425: 1423: 1421: 1419: 1417: 1415: 1413: 1411: 1409: 1407: 1403: 1398: 1394: 1390: 1386: 1381: 1380:10044/1/25730 1376: 1372: 1368: 1364: 1360: 1353: 1346: 1344: 1342: 1340: 1338: 1336: 1334: 1332: 1330: 1328: 1326: 1324: 1322: 1320: 1318: 1314: 1309: 1305: 1300: 1295: 1291: 1287: 1283: 1276: 1274: 1272: 1270: 1266: 1261: 1257: 1253: 1249: 1245: 1241: 1234: 1227: 1225: 1221: 1216: 1212: 1208: 1204: 1200: 1196: 1192: 1188: 1187: 1182: 1174: 1172: 1168: 1163: 1159: 1154: 1149: 1145: 1141: 1136: 1131: 1127: 1123: 1119: 1112: 1109: 1104: 1100: 1095: 1090: 1086: 1082: 1078: 1074: 1070: 1066: 1062: 1054: 1052: 1050: 1048: 1046: 1044: 1042: 1040: 1038: 1036: 1034: 1032: 1030: 1028: 1026: 1024: 1020: 1015: 1011: 1005: 1002: 997: 991: 987: 986: 978: 975: 970: 964: 960: 959: 951: 948: 943: 939: 935: 931: 927: 923: 916: 913: 908: 904: 900: 896: 892: 888: 884: 877: 875: 873: 871: 869: 867: 865: 863: 859: 853: 849: 846: 845: 841: 836: 835:L'Impératrice 832: 828: 825: 824: 819: 815: 814: 810: 808: 806: 805: 799: 796: 792: 786: 782: 775: 768: 766: 759: 757: 755: 751: 747: 738: 736: 734: 729: 727: 723: 719: 715: 714:phenylephrine 711: 707: 703: 699: 691: 689: 687: 686:beta blockers 683: 679: 672:Heart failure 671: 669: 667: 663: 659: 655: 651: 645: 641: 638: 629: 609: 605: 601: 597: 590: 585: 581: 574: 569: 565: 561: 554: 549: 542: 537: 535: 531: 529: 525: 521: 517: 512: 510: 506: 505:pathognomonic 501: 499: 495: 491: 487: 483: 479: 474: 472: 468: 464: 460: 455: 453: 449: 445: 441: 437: 428: 426: 424: 420: 415: 407: 404: 400: 396: 392: 388: 385: 381: 376: 373: 372: 371: 369: 365: 364:neuropeptides 356: 354: 352: 348: 344: 340: 336: 332: 328: 320: 318: 311: 309: 303: 301: 299: 294: 285: 280: 278: 276: 272: 268: 264: 258: 256: 252: 250: 245: 244:anterior wall 241: 237: 229: 227: 225: 224: 218: 216: 212: 207: 205: 201: 197: 193: 189: 185: 181: 177: 173: 169: 164: 162: 158: 154: 150: 146: 142: 137: 133: 129: 124: 122: 118: 114: 110: 105: 103: 99: 95: 92: 88: 84: 80: 72: 69: 67: 63: 58: 54: 49: 45: 41: 36: 30: 19: 4645:Cardiomegaly 4619:ST elevation 4606: 4592: 4578: 4559: 4463:Ectopic beat 4411:fibrillation 4246:Bifascicular 4120: 4101: 4082: 4058: 4028: 4014: 4007:Endocarditis 3946:Hypertrophic 3880:Constrictive 3866:Pericarditis 3824: 3812: 3795: 3632: 3608: 3597: 3582: 3567: 3529: 3525: 3511:25 September 3509:. 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Retrieved 1544: 1534: 1509: 1505: 1451: 1447: 1362: 1358: 1289: 1285: 1243: 1239: 1190: 1184: 1125: 1121: 1111: 1068: 1064: 1013: 1004: 984: 977: 957: 950: 928:(3): 218–9. 925: 921: 915: 893:(3): 370–5. 890: 886: 830: 821: 802: 800: 795:myofibrillar 787: 783: 780: 763: 760:Epidemiology 742: 730: 695: 675: 646: 644:situations. 642: 633: 594:ECG showing 532: 527: 523: 519: 515: 513: 502: 475: 456: 432: 416: 412: 405: 386: 374: 360: 324: 315: 307: 289: 281:Risk factors 271:chemotherapy 259: 248: 233: 221: 219: 215:octopus trap 210: 208: 165: 125: 106: 101: 86: 82: 78: 77: 29: 4511:Romano–Ward 4478:Parasystole 4377:Ventricular 4329:Ventricular 4268:Tachycardia 4185:Heart block 4167:Bradycardia 3993:Endocardium 3956:Restrictive 3917:Myocarditis 3858:Pericardium 3165:Circulation 2246:(1): 11–8. 2160:: 149–154. 1841:(8): 2435. 1622:Circulation 1448:Circulation 436:Mayo Clinic 391:epinephrine 380:endothelial 362:(including 265:, surgery, 43:Other names 4750:Categories 4409:Flutter / 4372:Junctional 4307:Junctional 4300:Multifocal 4273:paroxysmal 4189:Sinoatrial 4158:arrhythmia 4153:Conduction 3909:Myocardium 3610:DiseasesDB 3485:The Lancet 3460:9 December 3089:21 October 2951:StatPearls 2019:: 105063. 1550:9 February 1512:: 271–86. 854:References 831:Tako Tsubo 722:dobutamine 509:dyskinetic 486:chest pain 202:or severe 196:hemorrhage 132:adrenaline 71:Cardiology 4668:Pulmonary 4451:Pacemaker 4122:pulmonary 4103:tricuspid 3939:Alcoholic 3634:eMedicine 3538:2155-3017 3262:2305-5839 3185:0009-7322 3146:219156278 3130:1874-1754 3116:: 31–39. 3015:2 January 2821:cite book 2813:957316517 2117:0735-1097 1486:207581288 1470:1524-4539 1207:0098-7484 1144:1949-8462 1085:0195-668X 748:, lethal 739:Prognosis 706:inotropic 652:and very 630:Treatment 429:Diagnosis 327:endocrine 249:takotsubo 211:takotsubo 66:Specialty 4534:Asystole 4434:Familial 4128:stenosis 4109:stenosis 4090:stenosis 4071:stenosis 4066:prolapse 3788:Sequelae 3691:Ischemia 3506:54271789 3434:17455537 3280:30603648 3203:19106400 3138:32473281 3061:24964980 2995:19182280 2960:28613549 2923:BBC News 2905:10981859 2864:12897341 2749:22091255 2708:15996774 2673:16875987 2638:16948453 2608:17651841 2570:17067626 2534:17056345 2499:25043217 2457:31540920 2406:16182610 2365:12628715 2324:12923018 2260:11451258 2221:11868050 2186:23626469 2135:30309474 2070:24552225 2034:10963195 1960:33179374 1916:33117439 1867:32751501 1816:25068020 1752:17662398 1714:26935270 1644:22042929 1598:16720686 1526:19686084 1478:28606950 1397:24742760 1389:25855605 1308:29191302 1260:26332547 1215:21771988 1162:23888192 1103:29850871 942:18678857 907:18599137 842:See also 726:dopamine 712:, (e.g. 452:troponin 325:Certain 141:stunning 130:such as 91:ischemic 3934:Dilated 3876:Chronic 3684:(heart) 3604:D054549 3399:7399504 3364:5559442 3329:6047819 3320:1748842 3271:6312810 3194:4893309 2929:29 June 2740:3214344 2448:6768342 2315:1767823 2177:3632585 2126:7058348 2078:8577417 1907:7572168 1858:7465968 1807:4110608 1705:5841222 1153:3722420 1094:5991216 769:History 637:Aspirin 564:systole 562:during 423:avocado 339:thyroid 242:of the 145:tighten 4614:J wave 4367:Atrial 4295:Atrial 4084:aortic 4060:mitral 4052:Valves 3998:valves 3850:Layers 3719:(SCAD) 3593:429.83 3536: 3504: 3432: 3397: 3362: 3327: 3317: 3278: 3268: 3260: 3201: 3191: 3183: 3144: 3136: 3128: 3059: 2993: 2958: 2903: 2862: 2811: 2801: 2773:27 May 2747: 2737: 2706: 2671: 2636: 2606: 2568: 2532: 2497: 2455: 2445: 2404: 2363: 2322: 2312: 2258: 2219: 2184: 2174: 2133: 2123: 2115: 2076: 2068: 2031: 1958: 1914: 1904: 1865: 1855: 1814: 1804: 1750: 1712: 1702: 1642: 1596: 1524: 1484: 1476: 1468: 1395: 1387: 1306: 1258: 1213: 1205: 1160: 1150: 1142: 1101: 1091: 1083: 992: 965: 940: 905: 752:, and 684:, and 664:, and 604:T wave 419:wasabi 293:asthma 275:stroke 273:, and 263:asthma 180:stroke 119:, and 109:sepsis 4701:Other 4685:Right 4663:Right 4277:sinus 4226:Right 3976:Viral 3871:Acute 3825:weeks 3796:hours 3708:(CAD) 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