Management of Takotsubo Syndrome: A Comprehensive Review

Abstract

Takotsubo syndrome (TTS), also known as Takotsubo cardiomyopathy, is a transient left ventricular wall dysfunction that is often triggered by physical or emotional stressors. Although TTS is a rare disease with a prevalence of only 0.5% to 0.9% in the general population, it is often misdiagnosed as acute coronary syndrome. A diagnosis of TTS can be made using Mayo diagnostic criteria. The initial management of TTS includes dual antiplatelet therapy, anticoagulants, beta-blockers, angiotensin-converting enzyme inhibitors or aldosterone receptor blockers, and statins. Treatment is usually provided for up to three months and has a good safety profile. For TTS with complications such as cardiogenic shock, management depends on left ventricular outflow tract obstruction (LVOTO). In patients without LVOTO, inotropic agents can be used to maintain pressure, while inotropic agents are contraindicated in patients with LVOTO. In TTS with thromboembolism, heparin should be started, and patients should be bridged to warfarin for up to three months to prevent systemic emboli. Our comprehensive review discussed the management in detail, derived from the most recent literature from observational studies, systematic review, and meta-analyses.

Keywords: acute coronary syndrome; cardiomyopathy; left ventricular outflow tract obstruction; takotsubo cardiomyopathy; takotsubo syndrome.

Figure 1. The PRISMA search strategy of the review

PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses

Figure 2. TTS diagnosis during the evaluation of ACS

ACS, acute coronary syndrome; LV, left ventricular; PCI, percutaneous coronary intervention; STEMI, ST-segment elevation myocardial infarction; TPA, tissue plasminogen activator; TTS, Takotsubo syndrome