From the Guidelines
Takotsubo cardiomyopathy should be treated with supportive care, including medications like beta-blockers, ACE inhibitors, and aspirin, until the heart recovers, which typically happens within days to weeks 1.
Diagnosis and Treatment
The condition is typically triggered by intense emotional or physical stress, such as the death of a loved one, a serious accident, or severe illness. Symptoms include chest pain, shortness of breath, and abnormal ECG readings similar to a heart attack.
- Imaging with ventriculography, echocardiography, or magnetic resonance imaging should be performed to confirm or exclude the diagnosis of stress (Takotsubo) cardiomyopathy 1.
- Patients should be treated with conventional agents (ACE inhibitors, beta blockers, aspirin, and diuretics) as otherwise indicated if hemodynamically stable 1.
- Anticoagulation should be administered in patients who develop LV thrombi 1.
Management and Outcome
The management of takotsubo syndrome involves a multidisciplinary approach, including cardiologists, psychologists, and other healthcare professionals 1.
- The use of catecholamines for patients with symptomatic hypotension is reasonable if outflow tract obstruction is not present 1.
- The use of IABP is reasonable for patients with refractory shock 1.
- Prophylactic anticoagulation may be considered to inhibit the development of LV thrombi 1.
Quality of Life and Mortality
While recovery is generally good, patients should follow up with cardiologists to monitor heart function and prevent recurrence 1.
- The condition affects women more frequently than men, particularly post-menopausal women.
- Unlike a heart attack, takotsubo doesn't involve blocked coronary arteries, and the heart muscle damage is usually reversible.
From the Research
Definition and Prevalence of Takotsubo Syndrome
- Takotsubo syndrome (TTS) is a transient left ventricular wall dysfunction often triggered by physical or emotional stressors 2.
- It is a rare disease with a prevalence of 0.5% to 0.9% in the general population 2.
- TTS can be misdiagnosed as acute coronary syndrome due to similar clinical presentations 2, 3.
Clinical Presentation and Diagnosis
- The clinical presentation of TTS can be indistinguishable from a myocardial infarction, with symptoms such as acute-onset chest pain, dyspnea, and changes on the ECG 3, 4.
- A diagnosis of TTS can be made using Mayo diagnostic criteria 2.
- TTS is more common in women, particularly those who are post-menopausal 3.
Management and Treatment
- The initial management of TTS includes dual antiplatelet therapy, anticoagulants, beta-blockers, angiotensin-converting enzyme inhibitors or aldosterone receptor blockers, and statins 2.
- Treatment is usually provided for up to three months and has a good safety profile 2.
- For TTS with complications such as cardiogenic shock, management depends on left ventricular outflow tract obstruction (LVOTO) 2.
- The effect of aspirin in TTS is still being studied, with conflicting results regarding its long-term treatment benefits 5.
Pathophysiology and Future Directions
- The pathophysiological mechanisms of TTS remain unknown, although current evidence suggests a catecholamine-induced myocardial stunning 3.
- TTS remains a poorly understood condition with substantial morbidity and mortality, and without robust evidence or clinical trials available for management 4.
- Future research is needed to address the unmet needs and provide insights into the clinical management of TTS 6, 4.