Takotsubo Syndrome

T akotsubo syndrome (TTS) is an acute heart failure syndrome that predominantly affects post-menopausal women. It is characterized by substantial morbidity and mortality, which equal those of acute coronary syndromes (ACS) and are still underappreciated (1). TTS and ACS share many clinical features on admission, and an estimated 1% to 2% of all patients with suspected ACS are finally diagnosed with TTS (2). However, knowledge of diagnostic criteria is often incomplete (e.g., regarding the possible coexistence of coronary artery disease [CAD]) and atypical forms are frequently not recognized, both of which contribute to the low reported incidence of TTS. In early years, the disease was considered to be typically preceded by an emotional trigger; however, recent studies demonstrate that physical triggers are equally important and that TTS may frequently occur without an evident trigger (1,3). A hallmark of TTS patients is the predominant prevalence of neuropsychiatric comorbidities (1,4,5). However, despite many efforts, the exact pathophysiological mechanism behind TTS remains elusive and primarily relies on assumptions (6).