DIAGNOSIS OF TAKOTSUBO CARDIOMYOPATHY (BROKEN HEART SYNDROME): CRITERIA AND DIFFERENTIATION FROM ACUTE MYOCARDIAL INFARCTION

Abstract

Takotsubo cardiomyopathy (TCM) is a significant cause of reversible acute heart failure that mimics the clinical presentation of acute coronary syndrome, posing important diagnostic and therapeutic challenges. This narrative review synthesizes recent evidence on diagnostic criteria, differentiation from acute myocardial infarction, and management strategies, highlighting the need for a multimodal approach integrating clinical findings, biomarkers, and imaging methods. It is estimated that TCM accounts for approximately 1–2% of cases admitted with suspected acute coronary syndrome, predominantly in postmenopausal women and frequently associated with triggers of physical or emotional stress. The pathophysiology involves catecholaminergic discharge, microvascular dysfunction, and myocardial toxicity, resulting in distinct morphological patterns of ventricular dysfunction (apical, basal, mid-ventricular, or focal) that do not respect a single coronary territory. This study emphasizes the central role of coronary angiography in excluding acute coronary occlusion and cardiac magnetic resonance imaging for tissue characterization, particularly due to the typical absence of late ischemic enhancement, corroborating the transient nature of the lesion. Although historically considered benign, the acute phase can present with serious complications, including cardiogenic shock, left ventricular outflow tract obstruction, and arrhythmias, requiring individualized supportive management and caution in the use of inotropes. It concludes that the precise distinction between Takotsubo cardiomyopathy (TCM) and infarction is crucial to avoid unnecessary interventions, optimize risk stratification, and guide therapy, with outpatient follow-up focused on functional recovery and prevention of recurrences.