Takotsubo Syndrome (TTS) is a poorly understood, but increasingly recognised form of reversible cardiac dysfunction. TTS predominantly affects older women but can occur in men, younger women, children and neonates.1-3 Most people make a rapid full recovery, but many have continued debilitating symptoms of chest pain (angina), shortness of breath, fatigue and palpitations that persist for months after the initial event, impacting negatively on quality of life.10-15 These symptoms are often dismissed by poorly informed clinicians as imaginary, or caused by anxiety.12,13 There is an erroneous belief that TTS is a benign condition,1,4,5 but recent longer-term data shows similar in hospital mortality rates for TTS and ST-elevation myocardial infarction (heart attack) with an increased mortality risk following discharge when compared with the general population.6-9 TTS recurrence is reported as being between 5-22% .1 Currently there is no agreed evidence-based management for TTS, leading to a variety of diagnostic practices, management, and prescribing.
References
1Pelliccia, F., Kaski, J.C., Crea, F. and Camici, P.G., 2017. Pathophysiology of Takotsubo Syndrome. Circulation, 135(24), pp.2426-2441.
2Lyon, A.R., Bossone, E., Schneider, B., Sechtem, U., Citro, R., Underwood, S.R., Sheppard, M.N., Figtree, G.A., Parodi, G., Akashi, Y.J. and Ruschitzka, F., 2016. Current state of knowledge on Takotsubo syndrome: a Position Statement from the Taskforce on Takotsubo Syndrome of the Heart Failure Association of the European Society of Cardiology. European Journal of Heart Failure, 18(1), pp.8-27.
3Y-Hassan S. 2014. Acute cardiac sympathetic disruption in the pathogenesis of the Takotsubo syndrome: a systematic review of the literature to date. Cardiovasc Revasc Med.;159:35–42.
4Omerovic, E. (2016). Takotsubo syndrome: not as benign as once believed. European Journal of Heart Failure, 18(6), 657–659.
5 Neil, C.J., Nguyen, T.H., Sverdlov, A.L., Chirkov, Y.Y., Chong, C.R., et al. 2012. Can we make sense of Takotsubo cardiomyopathy? An update on pathogenesis, diagnosis and natural history. Expert Review of Cardiovascular Therapy, 10(2), 215-221.
6Akashi, Y.J., Nef, H.M., & Lyon, A.R. (2015). Epidemiology and pathophysiology of Takotsubo Syndrome. Nature Reviews Cardiology, 12(7), 387-397.
7Templin C, Ghadri JR, Diekmann J, Napp LC, Bataiosu DR, et al. 2015. Clinical features and outcomes of Takotsubo (stress) cardiomyopathy. New England Journal of Medicine, 373:929–938.
8Stiermaier, T., Moeller, C., Oehler, K., Desch, S., Graf, T., Eitel, C., Vonthein, R., Schuler, G., Thiele, H., & Eitel, I. (2016). Long-term excess mortality in Takotsubo Cardiomyopathy: predictors, causes and clinical consequences. European Journal of Heart Failure, 18(6), 650-656.
9Redfors B, Vedad R, Angerås O, Råmunddal T, Petursson P, Haraldsson I, Ali A, Dworeck C, Odenstedt J, Ioaness D, Libungan B, Shao Y, Albertsson P, Stone GW, Omerovic E. 2015. Mortality in takotsubo syndrome is similar to mortality in myocardial infarction—A report from the SWEDEHEART1 registry. International Journal of Cardiology, 185:282–289.
10Dahlviken, R.M., Fridlund, B., & Mathisen, L. Women’s experiences of Takotsubo cardiomyopathy in a short-term perspective–a qualitative content analysis. Scandinavian Journal of Caring Sciences, 29(2), 258-267.
11Madias, J.E. (2016). Recurrence, lingering recovery course, mild variants, and “chronic” forms, of Takotsubo Syndrome. International Journal of Cardiology, 220, 70-71.
12Wallström, S., Ulin, K., Määttä, S., Omerovic, E., & Ekman, I. (2015). Impact of long-term stress in Takotsubo syndrome: Experience of patients. European Journal of Cardiovascular Nursing, 15(7), 522-528.
13Wallström, S., Ulin, K., Omerovic, E., & Ekman, I. (2016). Self-reported symptoms 8 weeks after discharge: A comparison of Takotsubo syndrome and myocardial infarction. International Journal of Cardiology, 224, 348-352.
14 Kato, K., Templin, C., Daimon, M., Ishibashi, I. and Kobayashi, Y., 2017. P1073Myocardial edema still remains in subacute phase after recovery of left ventricular systolic function in patients with takotsubo syndrome. European Heart Journal, 38 (suppl_1).
15Schwarz, K., Ahearn, T., Srinivasan, J., Neil, C.J., Scally, C., Rudd, A., Jagpal, B., Frenneaux, M.P., Pislaru, C., Horowitz, J.D., & Dawson, D.K. (2017). Alterations in cardiac deformation, timing of contraction and relaxation, and early myocardial fibrosis accompany the apparent recovery of acute stress-induced (Takotsubo) cardiomyopathy: an end to the concept of transience. Journal of the American Society of Echocardiography, doi: http://dx.doi.org/10.1016/j.echo.2017.03.016
