Takotsubo Syndrome

Takotsubo syndrome (TTS) has captured the imagination of the medical community and the public alike since it was first described three decades ago. Also known as ‘broken heart syndrome’ or ‘stress cardiomyopathy’, TTS predominantly affects older women. Whilst the presentation of TTS mimics an acute coronary syndrome, the natural history of TTS is more in keeping with an acute heart failure syndrome. Characteristically, albeit not exclusively, TTS patients present with a clinical history of a preceding negative emotional stress, unobstructed coronary arteries on angiography, and apical ballooning of the left ventricle on cardiac imaging. This chapter discusses TTS epidemiology, pathophysiology, clinical presentation, and outcomes. Sex differences are also discussed but as a smaller proportion of TTS patients are men, comparisons between sexes are challenging. Current evidence suggests that neuro-hormonal mechanisms and the sympathetic system are involved in the pathogenesis of TTS with a catecholamine surge being a key pathogenic player in TTS. The female preponderance in TTS has been attributed to an increased susceptibility of older women to the effects of physiological stress on the heart-brain axis and lower levels of oestrogen during menopause.