Takotsubo Syndrome: Optimizing Care with a Multidisciplinary Approach

Abstract

Symptoms of takotsubo syndrome (TTS) include acute and transient regional systolic dysfunction of the left ventricle, as well as a variety of wall-motion abnormalities. The clinical features of TTS, including initial symptoms, cardiac biomarkers, and electrocardiogram (ECG) changes, are similar to those of acute coronary syndrome, with the exception that TTS patients typically have no obstructive coronary artery disease. TTS primarily affects elderly women, and emotional or physical stress is a common cause of the disease. Exaggerated sympathetic stimulation associated with dysfunction of the limbic system has also been reported to be related to TTS occurrence. Cancer also induces emotional and physical stress. Therefore, optimization of TTS care should involve cardiac, neurological, psychiatric, and oncological approaches. The first step in optimizing TTS care is to diagnose it by cardiac means. Multimodality imaging, including ECG, echocardiogram, angiography, ventriculography, and cardiac magnetic resonance imaging, is indispensable for diagnosis, therapy management, and the evaluation of prognosis in the acute and chronic phases of TTS. The current cardiac approach during the acute phase is primarily supportive, with the goal of preventing life-threatening complications. As central nervous system diseases frequently trigger TTS, a neurological approach is also required. Appropriate psychiatric medication may reduce the risk of TTS recurrence, as not only psychiatric disorders themselves but also psychiatric medications can be the trigger for TTS. Several conditions are associated with TTS, including the novel coronavirus disease 2019. We present current knowledge of TTS in this review and describe how to optimize TTS care through a multidisciplinary approach.

Acute Cholecystitis in a Gastric Bypass Patient Complicated by Takotsubo Cardiomyopathy

“…TC is commonly caused by acute emotional stress, often among postmenopausal women, and involvement of psychiatry and/or neurology may be beneficial in the management ( 10 ). EKG changes such as ST or T wave changes in the anterior leads and elevated troponins should lead to suspicion of TC in certain patient populations especially if “stress” is reported and/or patients suffer from significant medical conditions.…”

“…Primarily, ballooning of the left ventricle is the key finding on echocardiography and typically occurs in the apex (75-80%) and less commonly is found in the midventricle (10-20%) ( 9 ). A recent review by Kinno and Ono emphasized the importance of an interdisciplinary approach to TC due to the multitude of factors that may lead to the condition ( 10 ).…”

Inverted Takotsubo Syndrome With HELLP Syndrome: A Case Report

“…In the International Takotsubo Diagnostic Criteria (InterTAK Diagnostic Criteria), levels of cardiac biomarkers, including troponin, are described as moderately elevated in most cases whereas levels of brain natriuretic peptide (BNP) are substantially elevated. Some exceptions have been reported, however ( 1 , 3 ).…”

“…Takotsubo syndrome affects women more often than men and, commonly, 60–75-year-olds; thus, at onset, it can be mistaken for acute coronary syndrome. Although its exact pathophysiology is unknown, the main hypothesis is that it is due to exaggerated sympathetic stimulation, inducing a catecholamine excess, which seems to be more increased in Takotsubo syndrome than in acute myocardial infarction ( 1 ).…”

“…The effect of Takotsubo syndrome on circulating cardiac biomarkers is controversial. Two types of cardiac biomarker—natriuretic peptides and cardiac troponins—are used in the diagnosis of both Takotsubo syndrome and acute myocardial infarction ( 1 , 2 ). In the International Takotsubo Diagnostic Criteria (InterTAK Diagnostic Criteria), levels of cardiac biomarkers, including troponin, are described as moderately elevated in most cases whereas levels of brain natriuretic peptide (BNP) are substantially elevated.…”