Abstract:
Takotsubo syndrome (TTS), triggered by intense emotional or physical stress, occurring most commonly in post-menopausal women, presents as an ST-elevation myocardial infarction (MI). Cardiovascular complications occur in almost half the patients with TTS, and the inpatient mortality is comparable to MI (4–5%) owing to cardiogenic shock, myocardial rupture, or life-threatening arrhythmias. Thus, its prognosis is not as benign as previously thought, as it may cause mechanical complications (cardiac rupture) and potentially lethal arrhythmias and sudden cardiac death (SCD). Similar to MI, some patients may perish before reaching the hospital due to out-of-hospital cardiac arrest; this may lead to underestimation of the actual SCD risk. Furthermore, after discharge, some patients may develop late SCD and/or TTS recurrence that may result in SCD. There are risk factors for SCD in TTS patients, such as severe/persistent QT-interval prolongation inciting torsade-de-pointes, other ECG abnormalities (diffuse giant negative T-waves, widened QRS-complex), bradyarrhythmias, comorbidities, concurrent obstructive coronary artery disease or vasospasm, male gender, older age, severe left ventricular dysfunction, and use of sympathomimetic drugs. All these issues are herein reviewed, case reports/series and data from large cohort studies and meta-analyses are analyzed, risk factors are tabulated, and proarrhythmic effects and management strategies are discussed and pictorially illustrated. © The Author(s) 2022.
Authors:
Manolis, A.A.
Manolis, T.A.
Melita, H.
Manolis, A.S.
Keywords:
aciclovir; adrenergic receptor stimulating agent; amiodarone; antiarrhythmic agent; atorvastatin; catecholamine; dipeptidyl carboxypeptidase; dobutamine; interleukin 6; levosimendan; lidocaine; magnesium sulfate; metoprolol; noradrenalin; normetadrenalin; proton pump inhibitor; sodium glucose cotransporter 2 inhibitor; troponin I, acute heart infarction; acute kidney failure; artificial ventilation; atrial fibrillation; atrioventricular block; atrioventricular conduction; bradycardia; Brugada syndrome; cardiogenic shock; cardiovascular disease; cardiovascular magnetic resonance; cardioversion; cerebrovascular accident; chronic obstructive lung disease; computer assisted tomography; contrast echocardiography; coronary angiography; coronavirus disease 2019; defibrillation; dyspnea; ECG abnormality; echocardiography; electric conductivity; electrocardiogram; electrocardiography; electroencephalography; electrolyte balance; emotional stress; first degree atrioventricular block; heart arrest; heart arrhythmia; heart atrium flutter; heart catheterization; heart death; heart failure; heart infarction; heart left ventricle ejection fraction; heart muscle biopsy; heart pacing; heart repolarization; heart right ventricle outflow tract; heart ventricle arrhythmia; heart ventricle fibrillation; heart ventricle septum defect; heart ventricle tachycardia; hospital mortality; hospitalization; human; hyperlipidemia; hypertension; hypokalemia; hypotension; hypoxia; intensive care unit; long QT syndrome; lung embolism; meta analysis; mitral valve regurgitation; mortality; myocarditis; nuclear magnetic resonance imaging; out of hospital cardiac arrest; overall survival; oxidative stress; P wave; pacemaker implantation; percutaneous coronary intervention; physical stress; physiological stress; prevalence; QRS complex; QT interval; QTc interval; renal replacement therapy; resuscitation; Review; rhinoplasty; risk factor; seizure; sinus rhythm; ST segment elevation; ST segment elevation myocardial infarction; stunned heart muscle; sudden cardiac death; supraventricular tachycardia; systematic review; T wave; T wave inversion; tachycardia; takotsubo cardiomyopathy; thorax pain; vasospasm; complication; female; male; sudden cardiac death; takotsubo cardiomyopathy, Death, Sudden, Cardiac; Female; Humans; Male; Takotsubo Cardiomyopathy
