Takotsubo Cardiomyopathy

Takotsubo syndrome is an acute, usually reversible impairment of left ventricular systolic function with a regional wall-motion pattern that extends beyond the distribution of one epicardial coronary artery. Apical ballooning is the most familiar pattern, but mid-ventricular, basal, and focal variants occur. The ventricle is not simply facing a blocked pipe. Its myocardium has been temporarily stunned by catecholamine excess, with contributions from coronary microvascular dysfunction, impaired myocardial energy production, and dysregulation of the brain–heart axis. This explains the striking mismatch often seen at presentation: extensive ventricular dysfunction with a relatively modest troponin rise. An emotional or physical stressor supports the diagnosis but is not required. Pheochromocytoma and acute neurological disorders such as subarachnoid haemorrhage or stroke can trigger the syndrome; they do not exclude it. Significant coronary artery disease may coexist, so a plausible stress story or known coronary disease must not be used to bypass an acute coronary syndrome assessment. Approximately 90% of cases occur in women, predominantly after menopause, but this demographic pattern should not narrow clinical vigilance. Men have substantially higher in-hospital mortality, roughly twice that...