Tako-tsubo syndrome on the rise: a review of the current literature

Tako-tsubo syndrome (TTS) or stress-related acute reversible ventricular apical dysfunction is an emerging but seemingly under-recognised cardiomyopathy mimicking acute ST elevation myocardial infarction (STEMI) without concomitant epicardial coronary artery disease. Severe emotional stress is the most common trigger for this syndrome in the published series, but it can also be precipitated by severe intercurrent medical illness. Precise epidemiological data are not yet available, although TTS most commonly affects elderly women. The exact cause of this syndrome is undetermined, but proposed mechanisms include epicardial coronary artery vasospasm, impaired multivessel coronary microcirculation, calcium overload with direct myocyte damage and disrupted fatty acid metabolism with prolonged myocardial stunning. The time course of electrocardiographic changes is very similar to that of an acute STEMI due to an acute occlusion of the left anterior descending coronary artery. The left ventricular dysfunction typically displays an akinetic apical half of the left or both ventricles with hyperkinetic basal segments, although a variant with apical sparing has also been described recently. The ventricular dysfunction usually resolves within weeks and carries a generally favourable prognosis.