Skip to main content

Coexistent spontaneous coronary artery dissection and takotsubo syndrome: does one cause the other?

To the Editor,

I read with interest the paper by Saleemi et al., reporting on two women, 80- and 65-year old, who suffered both spontaneous coronary artery dissection (SCAD) and takotsubo syndrome (TTS) [1]. Although their gender and the emotional stress precipitants are in keeping with what is typical for both SCAD and TTS, their ages were atypical for SCAD, which usually is encountered in younger women [2], than the ones described herein [1]. In both patients SCAD affected the left anterior descending coronary artery, the vessel most often involved with SCAD [2]. In their second patient [1], the authors discuss the possibility that TTS could have been precipitated by the SCAD-induced chest pain; there is no much doubt that we will be witnessing more cases of simultaneous occurrence of SCAD and TTS in the future, and the authors’ point that it is important, when patients are diagnosed with TTS, that coronary angiograms are carefully scrutinized to exclude underlying SCAD [1] cannot be overemphasised. In addition, consideration should be given to the previously advanced hypothesis that TTS could potentially precipitate SCAD by an “excessive vigorous contraction of the left ventricle (LV) base in conjunction with the adjacent akinetic/dyskinetic systolic “ballooning” of the LV midmyocardium and apex”, which in predisposed individuals, “could form a prerequisite anatomic/functional substrate for the causation of SCAD [3]. Also, in exploring whether patients with diagnosed or suspected SCAD have also suffered a TTS, we should try, to implement early and frequently point of care ultrasound [4], following coronary angiography, to evaluate whether more patients with SCAD have also suffered TTS. Thus, pathophysiologically one should consider an amphidromic association between TTS and SCAD [1, 3, 5] at play.

Availability of data and material

Not applicable.



Left ventricle


Spontaneous coronary artery dissection


Takotsubo syndrome


  1. Saleemi SA, Teng LE, Dick RJL (2023) Combined spontaneous coronary artery dissection (SCAD) and Takotsubo syndrome (TTS): a case series. Egypt Heart J 75(1):35.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Saw J, Humphries K, Aymong E, Sedlak T, Prakash R, Starovoytov A, Mancini GBJ (2017) Spontaneous coronary artery dissection: clinical outcomes and risk of recurrence. J Am Coll Cardiol 70(9):1148–1158.

    Article  PubMed  Google Scholar 

  3. Madias JE (2015) On a plausible association of spontaneous coronary artery dissection and takotsubo syndrome. Can J Cardiol 31(11):1410.e1.

    Article  PubMed  Google Scholar 

  4. Madias JE (2021) COVID-19, POCUS, and Takotsubo. Am J Cardiol 141:157.

    Article  CAS  PubMed  Google Scholar 

  5. Madias JE (2017) A possible amphidromic relation between spontaneous coronary artery dissection and takotsubo syndrome. Am J Cardiol 120(3):e69.

    Article  PubMed  Google Scholar 

Download references




No funding was received for this work.

Author information

Authors and Affiliations



I am the single author of this commentary. The author conceived the idea, wrote, reviewed, and approved the final manuscript.

Corresponding author

Correspondence to John E. Madias.

Ethics declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The author declares that he has no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Madias, J.E. Coexistent spontaneous coronary artery dissection and takotsubo syndrome: does one cause the other?. Egypt Heart J 75, 84 (2023).

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: