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.
- 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%.