In recent years, our understanding of the physiologic mechanisms of transient takotsubo cardiomyopathy has improved because of the growing use of emergent heart catheterization in patients who present with severe ischemic syndromes. However, even this procedure has revealed only that, in most patients with takotsubo syndrome, the sudden onset of ventricular dysfunction is not due to fixed coronary artery occlusions. We present a case of transient takotsubo cardiomyopathy with an exceptional feature--uneven impairment of both right and left ventricular function, or biventricular takotsubo--and we discuss a novel, comprehensive theory that we have devised to explain the pathophysiology of this syndrome's many manifestations.
Keywords: Acetylcholine/diagnostic use; angina pectoris, variant; coronary endothelial dysfunction; coronary vasospasm/physiopathology; takotsubo cardiomyopathy/classification/diagnosis/physiopathology; ventricular dysfunction, left/etiology/diagnosis; ventricular dysfunction, right/etiology/diagnosis.