TakoTsubo Syndrome: A Well-Known Disease but Not Everything Is Clear Yet

Abstract

TakoTsubo Syndrome (TTS) is a stress-induced cardiac disease characterized by temporary and segmental left ventricle dysfunction, typically involving the apex. Post-menopause women are more frequently affected. ECG and clinical features at presentation may be similar to those observed in acute coronary syndrome (ACS). However underlying pathomechanisms are completely different and, for what concerns TTS, extremely debated and not yet completely understood. Some hypotheses have been proposed during years, mostly regarding catecholamine-induced cardiotoxicity and microvascular dysfunction, usually following a trigger event which may be either "emotional" (primary TTS) or "physical" (secondary TTS). Additional modulators like neuroendocrine disorders (particularly hypothalamic-pituitary-adrenal axis dysfunction and estrogen drop in menopause) may play a crucial role in TTS onset. Despite being originally considered more benign than ACS, several studies have enlightened that TTS and STEMI are burdened by the same inhospital mortality and complications. However, TTS and ACS complications somehow differ for what concerns incidence, the underlying mechanisms, and both long-and short-term outcomes. Full recovery in TTS requires weeks to months and cases of recurrences have been described, but no single clinical feature seems to predict subsequent episodes so far. By now, apart from inhibitors of the Renin-Angiotensin-Aldosterone System (RAASi), no drug has proved to be effective either in the acute or chronic phase in reducing mortality, improving outcome, or preventing recurrences.

Transient Left Ventricular Dysfunction from Cardiomyopathies to Myocardial Viability: When and Why Cardiac Function Recovers

“…Additionally, catecholamines like adrenaline or dobutamine actually cause vasodilation in coronary arteries, and preclinical models have shown that inducing TTS with catecholamines in the absence of endothelin can lead to apical dysfunction [26] without any abnormality in myocardial perfusion. However, secondary TTS can also occur in patients with mildly-obstructive CAD, who are more likely to have in-hospital complications and recurrences overtime [27]. In addition to the initial contractile dysfunction seen in TTS, it seems that long-term effects of high adrenaline may involve cardiac inflammation.…”

Attack the ATAK; A Challenging Contemporary Complex: Pathophysiologic, Therapeutic, and Preventive Considerations

“…10 , 11 Current international experts agree 11 about the common terminology of TS, although some aspects remain to be elucidated. 12 …”