Takotsubo syndrome: unravelling the enigma of the broken heart syndrome?—a narrative review

Abstract

Background and Objective Takotsubo syndrome (TTS) is a condition characterized by transient ventricular regional wall motion abnormalities, without causative coronary artery disease, typically triggered by emotional or physical stress. TTS is more common in post-menopausal women, closely resembling acute coronary syndrome (ACS) in its clinical presentation, with multiple proposed underlying pathophysiological mechanisms and no evidence-based treatments. This review aims to provide a comprehensive summary of the latest research, encompassing the pathophysiology, diagnostic findings, prognosis, and treatment options for TTS patients. Methods Relevant literature from 1990 to June 2023 on TTS epidemiology, physiopathology, diagnosis, clinical manifestations, treatment, and prognosis was retrieved through PubMed research. Only English publications were included. Key Content and Findings TTS is an increasingly recognized cardiovascular disorder, a significant release of catecholamines is thought to be a key contributing element, yet its exact mechanism remains unclear. Notably, TTS poses significant short and long-term risks akin to ACS. Initial treatment should focus on ruling out ACS and providing standard care for subsequent left ventricular dysfunction and complications. Research hints at a potential role for Angiotensin-converting enzyme inhibitors and Angiotensin II receptor blockers in improving long-term prognosis in TTS patients. Conclusions Significant knowledge gaps still exist in our understanding of the pathophysiology, treatment options, and areas for improvement in diagnosing and prognosticating this intriguing condition. Further research is therefore needed.

Transient Left Ventricular Dysfunction from Cardiomyopathies to Myocardial Viability: When and Why Cardiac Function Recovers

“…In instances of TTS, there has been evidence of microvascular dysfunction, which could help explain the characteristics of acute ischemic stunning [22]. The sudden surge in catecholamines in TTS likely leads to problems with the endothelium, which could make individuals more susceptible to vasospasms when provoked [23]. The prevalence of vascular dysfunction seems to vary among TTS patients and, in some cases, it has not been found at all [24].While endothelin levels are elevated in TTS and may hypothetically contribute to vasospasms, it is important to note that endothelin levels are also equally high in STEMI patients, where catecholamine-induced contractile dysfunction does not occur [25].…”