Terminology for Takotsubo Cardiomyopathy
"Catecholamine-induced cardiomyopathy" is not the preferred current term; the condition should be called "stress-induced cardiomyopathy" or "Takotsubo cardiomyopathy" according to the American Heart Association, though catecholamine excess is recognized as the primary pathophysiological mechanism. 1
Official Nomenclature
The American Heart Association's 2016 scientific statement uses "stress-induced cardiomyopathy" as the primary term, with "Takotsubo cardiomyopathy" as an acceptable alternative reference. 1 The term "catecholamine-induced cardiomyopathy" appears in the literature to describe the mechanistic basis but is not the standard diagnostic terminology. 2, 3
Why the Distinction Matters
The terminology reflects the clinical presentation rather than just the mechanism:
Stress-induced cardiomyopathy encompasses the full spectrum of emotional and physical triggers that precipitate the condition, not just direct catecholamine administration. 1
Takotsubo cardiomyopathy refers to the distinctive apical ballooning pattern resembling Japanese octopus catching pots, though variant forms exist. 1, 4
Catecholamine-induced cardiomyopathy is mechanistically accurate (supraphysiological catecholamine elevations are documented in acute episodes) but is too narrow as a diagnostic term since it doesn't capture the diverse triggering events. 1, 5
When "Catecholamine-Induced" Is Appropriate
The term "catecholamine-induced cardiomyopathy" is appropriately used in specific contexts:
Iatrogenic cases where exogenous catecholamine administration (norepinephrine, epinephrine, isoproterenol, dobutamine) directly triggers the syndrome during procedures. 2, 6
Mechanistic discussions explaining the pathophysiology involving β2-adrenergic receptor signaling switches and catecholamine-mediated myocardial stunning. 1, 5
Historical references to the decades-old recognition of catecholamine effects on myocardium. 2
Clinical Implications of Terminology
Using "stress-induced cardiomyopathy" or "Takotsubo cardiomyopathy" is clinically important because:
It prompts clinicians to identify both emotional stressors (grief, fear, anger) and physical stressors (acute illness, surgery, sepsis) as triggers. 4, 5
It emphasizes the characteristic reversibility and generally favorable prognosis when managed supportively. 7, 3
It signals avoidance of catecholamine-based inotropes (dobutamine) that could theoretically worsen the condition. 1, 7
It recognizes the brain-heart connection and interdisciplinary nature of the condition beyond purely cardiac pathology. 5
Common Pitfall
Do not use "catecholamine-induced cardiomyopathy" as the primary diagnostic term in clinical documentation or when communicating with patients. 1 This risks confusion with other catecholamine-related cardiac conditions (such as pheochromocytoma-induced cardiomyopathy) and fails to capture the broader clinical syndrome that includes the characteristic wall motion abnormalities, demographic predilection for postmenopausal women, and diverse triggering events. 4, 5