Takotsubo Syndrome: A Review of Presentation, Diagnosis and Management

Abstract

Takotsubo Syndrome (TTS) is a condition of transient left ventricular dysfunction that is typically triggered by emotional or physical stress. Since first described in Japan in 1990, it has increasingly been recognised in clinical practice, accounting for up to 2% of Acute Coronary Syndrome (ACS) presentations. In fact, the clinical presentation can be indistinguishable from a myocardial infarction. Although current evidence suggests a catecholamine induced myocardial stunning, the pathophysiological mechanisms remain unknown. Interestingly, it is more common in woman, particularly those who are post-menopausal. This review aims to summarise the current research and provide an overview of the diagnostic strategies and treatment options.

Keywords: Takotsubo cardiomyopathy; Takotsubo syndrome; broken heart syndrome; stress cardiomyopathy.

Figure 1.

A depiction of the subtypes of Takotsubo syndrome shown during both diastole (left) and systole (middle). The right column depicts diastole in red and systole in white, with the blue lines representing the region of WMA. Source: Reproduced and modified with permission from Templin et al.

Figure 2.

(a) Left ventriculogram right anterior oblique projection in end-systole demonstrating apical ballooning. (b) Four chamber transthoracic echocardiogram in end systole demonstrating apical ballooning. The area around the apex shows akinesis, and the basal segments display hypercontraction.

Figure 3.

Proposed diagnostic algorithm for patients presenting with chest pain or dyspnoea. Source: Adapted from Ghadri et al.

Figure 4.

Management of takotsubo syndrome. Reproduced from international expert consensus document on takotsubo syndrome (part II): diagnostic workup, outcome and management. Source: Adapted from Ghadri et al.