Approach to the patient with Takotsubo cardiomyopathy

Abstract

Takotsubo syndrome is defined as an alteration of the contraction of the heart, with a typical apical bulging and basal hypercontractility, in which hyperactivity of the amygdala and overstimulation by catecholamines play an important role, so it is common to have a physical or emotional stressful trigger. It mainly affects postmenopausal women, and its form of presentation is mainly with chest pain, like an ACS (acute coronary syndrome), it should differ mainly from a MINOCA (acute myocardial infarction without obstructive coronary injury) for this the diagnostic algorithm using the interTAK score is useful. Within its treatment is essential the stratification of risk into high or low risk, monitoring and ultrasound initially daily, due to risk of arrhythmias and other complications, each of these is treated individually. Treatment with beta-blockers is generally recommended in high-risk patients and/or with decreased LVEF (left ventricular ejection fraction); On the other hand, drugs that due to the pathophysiology of the syndrome could be counterproductive, such as inotropes and sympathomimetics, should be avoided. Subsequently, ultrasound should be followed up initially at 6 and 12 months and then performed annually. In-hospital mortality is up to 5%, however, the long-term prognosis is quite good, although some symptoms may persist, and recurrences are infrequent (although described).