From the Guidelines
Takotsubo syndrome, also known as stress cardiomyopathy or broken heart syndrome, is a temporary heart condition that mimics a heart attack but is caused by emotional or physical stress rather than blocked arteries, with a substantial incidence of life-threatening complications necessitating close monitoring and early intervention in unstable patients 1.
Key Characteristics
- The condition is characterized by acute, usually reversible left ventricular (LV) dysfunction in the absence of significant coronary artery disease (CAD), usually triggered by acute emotional or physical stress 1.
- It can present with symptoms similar to those of acute coronary syndrome and may have transiently elevated cardiac enzymes such as cardiac troponin 1.
- The characteristic ballooning of the left ventricle resembles a Japanese octopus trap (tako-tsubo), although other diverse ventricular contraction patterns have been defined by cardiovascular imaging 1.
Risk Factors and Complications
- Parameters predicting adverse in-hospital outcome include physical trigger, acute neurologic or psychiatric diseases, initial troponin >10 upper reference limit, and admission LVEF <45% 1.
- Male patients have an up to three-fold increased rate of death and major adverse cardiac and cerebrovascular events (MACCE) and more often had an underlying critical illness, further contributing to the higher mortality 1.
- Complications included cardiac death, pump failure, sustained ventricular tachycardia or ventricular fibrillation, and advanced atrioventricular block 1.
Treatment and Outcome
- Treatment focuses on supportive care while the heart recovers, typically including ACE inhibitors, beta-blockers, and aspirin for 1-3 months until heart function normalizes 1.
- In severe cases with heart failure symptoms, diuretics like furosemide may be needed 1.
- Most patients recover completely within 1-3 months with no permanent heart damage, although recurrence is possible (10-15% of cases) 1.
From the Research
Definition and Characteristics of Takotsubo Syndrome
- Takotsubo syndrome (TS) is an acute heart failure syndrome characterized by a sudden weakening of the heart muscle, usually triggered by physical or emotional stress 2, 3, 4, 5, 6.
- It is often misdiagnosed as acute coronary syndrome due to similar symptoms and electrocardiographic changes 3, 5.
- TS is self-limiting in most cases but can result in life-threatening complications, including cardiogenic shock, pulmonary edema, thromboembolism, and arrhythmias 2, 5.
Diagnosis and Management
- Diagnosis of TS can be made using Mayo diagnostic criteria, and cardiac imaging is critical for a timely diagnosis 3, 5.
- Management of TS should focus on careful monitoring of ECG and hemodynamics, and on preventing and treating complications 2.
- Treatment may include beta-blockers, angiotensin-converting enzyme inhibitors, and statins, but the use of inotropic agents is generally contraindicated, especially in patients with left ventricular outflow tract obstruction (LVOTO) 2, 3, 4.
- Mechanical assist devices should be considered early for patients with TS who develop cardiogenic shock with signs of end-organ hypo-perfusion 2.
Pathophysiology and Prognosis
- The mechanism behind TS remains elusive, but multiple theories have been proposed, including an acute increase in left ventricular afterload, multi-vessel coronary vasospasm, coronary endothelial microvascular dysfunction, and inflammation 5, 6.
- TS has substantial morbidity and mortality, with a probability of all-cause mortality of 2.5% after 30 days and 16.6% after 6 years 4.
- Certain pharmacological interventions, such as angiotensin-converting enzyme inhibitors and statins, may be associated with decreased long-term mortality, while others, such as inotropes and diuretics, may be associated with increased 30-day mortality 4.