Takotsubo cardiomyopathy (TTC), a persistently obscure dysfunctional condition of the left ventricle, is uniquely transient but nevertheless dangerous. It features variable ventricular patterns and is predominant in women. For 30 years, pathophysiologic investigations have progressed only slowly and with inadequate focus.

It was initially proposed that sudden-onset spastic obliteration of coronary flow induced myocardial ischemia with residual stunning and thus TTC. Later, it was generally accepted without proof that, in the presence of pain or emotional stress, the dominant mechanism for TTC onset was a catecholamine surge that had a direct, toxic myocardial effect.

We think that the manifestations of TTC are more dynamic and complex than can be assumed from catecholamine effects alone. In addition, after reviewing the recent medical literature and considering our own clinical observations, especially on spasm, we theorize that atherosclerotic coronary artery disease modulates and physically opposes obstruction during spasm. This phenomenon may explain the midventricular variant of TTC and the lower incidence of TTC in men. We continue to recommend and perform acetylcholine testing to reproduce TTC and to confirm our theory that coronary spasm is its initial pathophysiologic factor. An improved understanding of TTC is especially important because of the condition's markedly increased incidence during the ongoing COVID-19 pandemic.

Takotsubo 心肌病 (TTC) 是一种持续不明显的左心室功能障碍，虽然是短暂的，但仍然很危险。它具有可变的心室模式，并且在女性中占主导地位。30 年来，病理生理学研究进展缓慢且关注度不够。

最初提出冠状动脉血流的突然发作痉挛性闭塞会导致心肌缺血并伴有残余电击和 TTC。后来，人们普遍接受，但没有证据表明，在存在疼痛或情绪压力的情况下，TTC 发病的主要机制是儿茶酚胺激增，它具有直接的毒性心肌效应。

我们认为 TTC 的表现比仅从儿茶酚胺效应所能假设的更加动态和复杂。此外，在回顾了最近的医学文献并考虑到我们自己的临床观察，特别是对痉挛的观察后，我们推测动脉粥样硬化性冠状动脉疾病在痉挛期间调节和物理对抗阻塞。这种现象可以解释 TTC 的心室中部变异和男性 TTC 的发生率较低。我们继续推荐并进行乙酰胆碱测试以重现 TTC 并证实我们的理论，即冠状动脉痉挛是其最初的病理生理因素。由于在持续的 COVID-19 大流行期间该病的发病率显着增加，因此更好地了解 TTC 尤为重要。