Takotsubo cardiomyopathy: Pathogenesis, natural history and prognosis

Takotsubo cardiomyopathy (TCM) is a condition classically characterized by transient apical hypokinesis with preserved basal systolic function in the setting of unobstructed coronary arteries. First described in the early 1990‘s, it was initially thought to be a rare disease. However, TCM has been increasingly reported and described, now with new atypical variants of differing hypokinetic cardiac segments involved. It is also known as apical ballooning syndrome or stress induced cardiomyopathy, reflecting its characteristic imaging finding and underlying pathophysiology. While many cases of TCM present similarly to those of acute coronary syndrome, the hallmark of the syndrome is the lack of myocardial abnormality in a well-defined coronary distribution. Predisposing factors stem from the pathophysiology of this condition, where intense physical or emotional stress triggers catecholamine release, leading to vascular dysfunction and myocardial involvement. Given the transient nature of the syndrome, prognosis is generally favorable compared to other acute cardiac emergencies. However, with greater understanding of the underlying pathogenesis as well as greater recognition of this phenomenon, management has become more sophisticated, evolving from supportive therapy alone to treatment and prevention of potential complications, such as shock, thromboembolism and arrhythmias.