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Feature Article

Takotsubo syndrome. What becomes of the broken hearted?

Avalon Moonen, Jo-Dee Lattimore

Figures

© SCIENCE SOURCE/GWEN SHOCKY/ MEDICAL IMAGES
© SCIENCE SOURCE/GWEN SHOCKY/ MEDICAL IMAGES

Abstract

Often considered to run a benign and self-limiting course, the darker prognosis of takotsubo cardiomyopathy is increasingly being recognised, with up to a quarter of affected patients having severe clinical complications. Early diagnosis requires excluding acute coronary syndromes, and recognition of high-risk prognostic features may help to minimise morbidity and mortality.

Key Points

  • Takotsubo syndrome (TTS) is a transient cardiomyopathy provoked by catecholamine surge.
  • A triggering stressful event, which may be emotional, physical or psychological, is present in two-thirds of patients with TTS.
  • Postmenopausal women comprise 90% of patient with TTS.
  • TTS presents as an acute coronary syndrome mimic and diagnosis requires exclusion of coronary disease.
  • Risk factors for poor outcomes from TTS include older age, physical stress as a trigger and atypical patterns of left ventricular dysfunction.
  • The inhospitable rate of serious complications is about 20% and the risk of inhospitable death is 1.8%.
  • Management is predominantly supportive until cardiac dysfunction improves.
  • Observational data indicate treatment with ACE inhibitors and angiotensin receptor blockers may improve survival at one year.
  • TTS has a recurrence rate of 1%.

Figures

© SCIENCE SOURCE/GWEN SHOCKY/ MEDICAL IMAGES
© SCIENCE SOURCE/GWEN SHOCKY/ MEDICAL IMAGES