Abstract

Stress cardiomyopathy, also known as apical ballooning syndrome or takotsubo cardiomyopathy, is traditionally associated with acute emotional or physical stress. However, recent evidence reveals a range of unusual triggers that can lead to this transient form of heart failure including medical and surgical procedures, neurological events (i.e., seizures and strokes), chronic psychological stress, and endocrine disorders such as hypoglycemia, pharmacological agents, infectious diseases (i.e., sepsis and COVID-19), and environmental stressors such as extreme temperatures or high altitudes. Despite the variety of these triggers, they share a common pathophysiology, primarily involving an excessive catecholamine surge that results in myocardial stunning. Recognizing these unusual causes and presentations is essential for timely diagnosis and appropriate management.