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Takotsubo syndrome 

Takotsubo syndrome
Takotsubo syndrome

Alexander Lyon

, Mark Sweeney

, and Elmir Omerovic


July 29, 2020: This chapter has been re-evaluated and remains up-to-date. No changes have been necessary.

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date: 27 February 2021

Takotsubo syndrome is an acute heart failure syndrome characterized by acute, reversible ventricular dysfunction, often in response to a physical or an emotional stressor. Takotsubo syndrome mimics acute myocardial infarction, presenting as chest pain or breathlessness, with electrocardiographic changes and troponin elevation, but with no explanatory coronary artery lesions on coronary angiography. It is increasingly commonly recognized in recent years as a cause of acute chest pain presentations. Although the majority of patients have a good prognosis following an episode of Takotsubo syndrome, it is becoming apparent that there is a significant burden of morbidity and mortality associated with this condition. The pathophysiology is likely to relate to an acute surge of catecholamines in response to stress, which results in multiple effects on the myocardium and vascular system. Currently, trial evidence is lacking, and management is based on clinical opinion, with optimal supportive care and avoidance of catecholamines as the mainstay of treatment in the acute phase. Non-catecholamine-related inotropes, such as levosimendan, have been reported in patients who require inotropic support, with anecdotal success. However, early consideration of referral to specialist centres for mechanical circulatory support is important in these severe cases. Evidence for medication to minimize recurrence is limited. Some observational data suggest angiotensin-converting enzyme inhibitors and beta-blockers may be beneficial in reducing mortality and preventing recurrence. However, there are no prospective data to inform treatment, and current management is guided by expert consensus.

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