From the Guidelines
The management of Takotsubo cardiomyopathy should focus on supportive care, including the use of beta-blockers, ACE inhibitors, and diuretics, as well as careful monitoring for complications such as left ventricular outflow tract obstruction and thrombus formation, as recommended by the 2018 international expert consensus document on Takotsubo syndrome 1. The initial treatment approach should prioritize standard heart failure therapy, with medications such as:
- Beta-blockers (e.g., metoprolol 25-50mg twice daily) to reduce the risk of recurrent events and improve left ventricular function
- ACE inhibitors (e.g., enalapril 2.5-5mg twice daily) to facilitate left ventricular recovery and reduce mortality
- Diuretics (e.g., furosemide 20-40mg daily) to manage fluid overload and alleviate symptoms In hemodynamically unstable patients, inotropic support with dobutamine or mechanical circulatory support may be necessary to maintain cardiac function and prevent further complications. Anticoagulation with heparin followed by warfarin (target INR 2-3) for 1-3 months may be recommended if left ventricular thrombus is present or if severe left ventricular dysfunction exists, as suggested by the 2018 expert consensus document 1. Regular follow-up with echocardiography is essential to confirm recovery of left ventricular function and monitor for potential recurrence, which can occur in approximately 5% of cases, as reported in the 2018 international expert consensus document on Takotsubo syndrome 1. It is also crucial to identify and address underlying triggers, such as emotional or physical stressors, to prevent future episodes and improve overall quality of life, as emphasized in the 2018 expert consensus document 1.
From the Research
Cm Takosubo Management
- The management of Takotsubo cardiomyopathy is largely supportive 2.
- Treatment may include angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) to reduce the likelihood of recurrent episodes 2.
- The prognosis is very good, with about 95% of patients making a full recovery 2.
Treatment Principles
- Management of Takotsubo syndrome is currently empirical and supportive, via extrapolation of therapeutic principles worked out for other cardiovascular pathologies 3.
- Therapy for Takotsubo cardiomyopathy may be in response to pathophysiological/pathoanatomic/pathohistological consequences, common to both Takotsubo cardiomyopathy and coronary artery disease, or other cardiovascular disorders 3.
- Some new therapeutic hypotheses, such as large doses of insulin infusions in association with the employment of intravenous short- and ultrashort-acting β-blockers, are being entertained 3.
Pharmacological Treatment
- Chronic pharmacological treatment with ACE-inhibitors, beta-blockers, Aspirin, and calcium channels blockers does not provide any benefit in patients with Takotsubo cardiomyopathy 4.
- No significant differences were found in hospitalization times between treated patients and controls, and none of the patients experienced a relapse of the disease during the observation period 4.
Anesthetic Management
- Minimizing perioperative anxiety should be a priority in patients with Takotsubo cardiomyopathy due to the possibility that a catecholamine discharge might trigger an episode of Takotsubo cardiomyopathy 5.
- Proper preoperative sedation and hyperbaric spinal anesthesia, followed by sedation with intravenous propofol, can be used in the anesthetic management of these patients 5.