The specific mechanisms leading to Takotsubo syndrome remain controversial but seem to be rooted in a catecholamine surge – or in layperson’s terms, an “adrenaline rush.” Two hormones, epinephrine, and norepinephrine are typically released from nerves and our adrenal glands during stressful situations (our “fight or flight” response). These hormones cause our heart muscles to contract more forcefully. This requires greater blood flow through the coronary arteries to supply oxygen to the cardiac muscle cells. Under normal circumstances, such as exercise, the heart can maintain a healthy balance between oxygen supply and the heart’s demand. This balance is disrupted during the initial stages of Takotsubo syndrome.

During the early stages of Takotsubo syndrome, these catecholamine stress hormones are often highly elevated compared to patients having a heart attack. In patients with Takotsubo syndrome, these high levels of catecholamine hormones may cause direct damage to the heart muscle itself while also triggering smaller blood vessels within the heart to spasm. This disrupted blood flow causes signs and symptoms very similar to that of a typical heart attack, as both mechanisms ultimately starve the heart muscle of oxygen.