Introduction on Takotsubo Syndrome – Stress-induced Heart Failure Syndrome
Takotsubo syndrome is an acute reversible heart failure syndrome, which is increasingly recognised by coronary angiography for patients with acute ‘cardiac’ chest pain.1 It is a distinct disease entity from acute coronary syndrome, although the initial presentation has similar features to either ST elevation myocardial infarction (STEMI) or non-ST elevation myocardial infarction (NSTEMI). Early access to diagnostic coronary angiography has helped identify the increasing incidence of this condition and over the past 24 years there has been increase in the number of case reports, series and registries reported.2
Nomenclature
Various names have been used to describe the appearance now described as Takotsubo cardiomyopathy or Takotsubo syndrome, following the initial label given by Sato and colleagues in 1990, comparing the appearance of the left ventricle at end-systole to the local Japanese fishermen’s octopus pots in the Hiroshima fishing markets.3 Many names have been used for the condition, including stress or stress-induced cardiomyopathy, apical ballooning syndrome,4 ampullary-shaped cardiomyopathy5,6 and ‘broken-heart’ syndrome in the context of bereavement.7 While it is a form of acute heart failure, one of the characteristics contributing to the definition is the recovery of the dysfunctional myocardial segments. The majority of patients recover normal cardiac function and patients have a low risk of major adverse cardiac events. The term cardiomyopathy implies a primary disease of the cardiac muscle, but the full recovery and low major adverse cardiac event rate at follow up show major differences with the primary cardiomyopathies. The consensus is that as the diagnosis of Takotsubo syndrome is currently made based upon clinical observations, it fulfils the definition of a clinical syndrome rather than a cardiomyopathy.
Definition
Takotsubo syndrome and its associated variants constitute a type of acute, reversible heart failure that may represent a form of acute catecholaminergic myocardial stunning in the absence of culprit occlusive coronary artery disease to explain the pattern of temporary left ventricular (LV) dysfunction.8–11 Several diagnostic criteria strategies have been proposed, including those by the Mayo Clinic (modified in 2008), the Japanese Takotsubo Cardiomyopathy Group, the Gothenburg Group and the Takotsubo Italian Network.12–16 The author was part of the working group that developed the new 2014 European Society of Cardiology (ESC) Takotsubo Syndrome Diagnostic Criteria (see below). It is important to note that whilst this condition predominantly affects post-menopausal women (~90 % of all cases reported, particularly in the larger cohorts), men and younger women can also from suffer the condition and therefore demographic features are not a mandatory part of the proposed diagnostic criteria.