Takotsubo Cardiomyopathy

Takotsubo cardiomyopathy, also known as stress-induced cardiomyopathy, apical ballooning syndrome or broken heart syndrome, is characterized by acute, transient cardiac dysfunction following a significant catecholaminergic disturbance. It is a relatively newly described clinical phenomenon, with incompletely understood socio-environmental mediating factors and neurohormonal mechanisms implicated in the pathophysiology. It is more commonly seen in females. The diagnosis requires a thorough clinical history and the use of multimodality assessment commonly including angiography and echocardiography, with computed tomography and magnetic resonance imaging used in some cases. The prognosis of patients with Takotsubo cardiomyopathy and of patients with acute coronary syndrome are similar, with high burden of cardiogenic shock (6–20%) and mortality (1–8% in hospital, 3.5–5.6% annual rate). Treatment in the acute setting is mainly supportive with monitoring and treatment of life-threatening arrhythmias and cardiogenic shock. Longer term therapies addressing the complex underpinnings of this condition (i.e. left ventricular remodelling, neurohormonal pathways, and psychosocial and environmental factors) are still under investigation. This chapter reviews the epidemiology, pathophysiology, clinical manifestations, and diagnosis of takotsubo cardiomyopathy. The management and prognosis of takotsubo cardiomyopathy will also be reviewed.