From the Guidelines
Takotsubo cardiomyopathy is a temporary heart condition that should be managed with supportive care, including beta-blockers, ACE inhibitors, and aspirin, with a focus on identifying and managing triggering stressors to improve morbidity, mortality, and quality of life outcomes. The condition typically presents with sudden chest pain, shortness of breath, and ECG changes that resemble a heart attack, and is characterized by temporary ballooning of the left ventricle 1. The pathogenesis of Takotsubo cardiomyopathy has been attributed to excess catecholamine release, coronary spasm, or small coronary vessel hypoperfusion 1.
Key Considerations
- The condition predominantly affects postmenopausal women, with 90% of patients in the International Takotsubo Registry being women with a mean age of 66.8 years 1.
- Treatment should include medications like beta-blockers (such as metoprolol 25-100 mg twice daily), ACE inhibitors (such as lisinopril 5-40 mg daily), and aspirin (81-325 mg daily) to manage symptoms and prevent complications 1.
- Prophylactic anticoagulation may be considered to inhibit the development of LV thrombi, although the evidence for this is limited 1.
- Follow-up echocardiograms should be scheduled at 4-6 weeks after the initial event to confirm recovery of heart function 1.
Management and Outcomes
- Most patients recover completely within weeks as the heart muscle heals 1.
- The prognosis is generally good with a low recurrence rate (about 5-10%) 1.
- However, long-term follow-up has revealed substantial morbidity and mortality, with a rate of death at 5.6% per patient-year 1.
- Therefore, it is essential to prioritize supportive care and management of triggering stressors to improve outcomes in patients with Takotsubo cardiomyopathy.
From the Research
Definition and Prevalence
- Takotsubo cardiomyopathy (TTS), also known as Takotsubo cardiomyopathy, is a transient left ventricular wall dysfunction that is often triggered by physical or emotional stressors 2.
- The prevalence of TTS is estimated to be around 0.5% to 0.9% in the general population 2, and it is estimated to represent 1%-2% of patients presenting with acute myocardial infarction 3.
Clinical Features and Diagnosis
- TTS is characterized by a clinical presentation indistinguishable from myocardial infarction, with chest pain and dyspnea being the typical presenting symptoms 3.
- Transient ST-segment elevation on ECG and a small rise in cardiac biomarkers are common 3.
- Characteristic wall motion abnormalities extend beyond the territory of a single epicardial coronary artery in the absence of obstructive coronary lesions 3.
- A diagnosis of TTS can be made using Mayo diagnostic criteria 2.
Treatment and Management
- 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.
- In patients without LVOTO, inotropic agents can be used to maintain pressure, while inotropic agents are contraindicated in patients with LVOTO 2.
- Chronic pharmacological treatment with ACE-inhibitors, beta-blockers, calcium channels blockers, and aspirin does not provide any benefit in patients with TTS 4.
Prognosis and Complications
- The prognosis for TTS is generally good, with supportive treatment leading to spontaneous rapid recovery in nearly all patients 3.
- However, there is a high risk of complications at the initial presentation, including hypotension, heart failure, ventricular rupture, thrombosis involving the LV apex, and torsade de pointes 5, 6.
- Recurrence occurs in < 10% of patients 3.