Takotsubo Syndrome: Optimizing Care with a Multidisciplinary Approach

Ryuta Kinno,1 Kenjiro Ono2 1Division of Neurology, Department of Internal Medicine, Showa University Northern Yokohama Hospital, Yokohama City, Kanagawa, 224-8503, Japan; 2Division of Neurology, Department of Medicine, Showa University School of Medicine, Tokyo, 142-8555, JapanCorrespondence: Ryuta KinnoDivision of Neurology, Department of Internal Medicine, Showa University Northern Yokohama Hospital, 35-1 Chigasakichuo, Tsuzuki-ku, Yokohama City, Kanagawa, 224-8503, JapanTel +81-45-949-7000Fax +81-45-949-7293Email kinno@med.showa-u.ac.jpAbstract: Symptoms of takotsubo syndrome (TTS) include acute and transient regional systolic dysfunction of the left ventricle, as well as a variety of wall-motion abnormalities. The clinical features of TTS, including initial symptoms, cardiac biomarkers, and electrocardiogram (ECG) changes, are similar to those of acute coronary syndrome, with the exception that TTS patients typically have no obstructive coronary artery disease. TTS primarily affects elderly women, and emotional or physical stress is a common cause of the disease. Exaggerated sympathetic stimulation associated with dysfunction of the limbic system has also been reported to be related to TTS occurrence. Cancer also induces emotional and physical stress. Therefore, optimization of TTS care should involve cardiac, neurological, psychiatric, and oncological approaches. The first step in optimizing TTS care is to diagnose it by cardiac means. Multimodality imaging, including ECG, echocardiogram, angiography, ventriculography, and cardiac magnetic resonance imaging, is indispensable for diagnosis, therapy management, and the evaluation of prognosis in the acute and chronic phases of TTS. The current cardiac approach during the acute phase is primarily supportive, with the goal of preventing life-threatening complications. As central nervous system diseases frequently trigger TTS, a neurological approach is also required. Appropriate psychiatric medication may reduce the risk of TTS recurrence, as not only psychiatric disorders themselves but also psychiatric medications can be the trigger for TTS. Several conditions are associated with TTS, including the novel coronavirus disease 2019. We present current knowledge of TTS in this review and describe how to optimize TTS care through a multidisciplinary approach.Keywords: cardiac approach, neurological approach, psychiatric approach, oncological approach, limbic system, exaggerated sympathetic stimulatio