Gut Feelings and Broken Hearts: A Case of Small Bowel Obstruction Causing Takotsubo Cardiomyopathy.

Takotsubo cardiomyopathy (TCM), also known as apical ballooning syndrome or stress-induced cardiomyopathy, typically presents with features of the acute coronary syndrome. It is characterized by left ventricular apical akinesis and transient systolic dysfunction in the absence of obstructive coronary artery disease. Although its pathogenesis remains unclear, it is thought to be a catecholamine surge that is produced following intense physical or emotional stress.

Uncoupled cardiac nitric oxide synthase mediates diastolic dysfunction.

Background: Heart failure with preserved ejection fraction is 1 consequence of hypertension and is caused by impaired cardiac diastolic relaxation. Nitric oxide (NO) is a known modulator of cardiac relaxation. Hypertension can lead to a reduction in vascular NO, in part because NO synthase (NOS) becomes uncoupled when oxidative depletion of its cofactor tetrahydrobiopterin (BH(4)) occurs.