Abstract
Takotsubo syndrome (TTS) represents a form of acute heart failure featured by reversible left ventricular systolic dysfunction. The management during the acute phase is mainly performed with supportive pharmacological (diuretics, ACE-inhibitors/angiotensin-receptor blockers (ARBs), anticoagulants, antiarrhythmics, non-catecholamine inotropics (levosimendan), and non-pharmacological (mechanical circulatory and respiratory support) therapy, due to the wide clinical presentation and course of the disease. However, there is a gap in evidence and there are no randomized and adequately powered studies on clinical effectiveness of therapeutic approaches. Some evidence supports the use ACE-inhibitors/ARBs at long-term. A tailored approach based on cardiovascular and non-cardiovascular risk factors is strongly suggested for long-term management. The urgent need for evidence-based treatment approaches is also reflected by the prognosis following TTS. The acute phase of the disease can be accompanied by various cardiovascular complications. In addition, long term outcome of TTS patients is also related to non-cardiovascular comorbidities. Physical triggers such as hypoxia and acute neurological disorders in TTS are associated with a poor outcome.
Highlights
Challenges in Takotsubo Syndrome: Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy; Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Heart Center, German Center for Cardiovascular Research (DZHK), 23552 Lübeck, Germany
Patients are generally treated with several supportive measures, pharmacological (beta-blockers, diuretics, anticoagulants, antiarrhythmics, non-catecholamine inotropics), and nonpharmacological, depending on the grade of heart failure and the existence of concomitant complications
Med. 2021, 10, 468 absence of left ventricular outflow tract obstruction, levosimendan infusion may 3 ofbe considered; in case of cardiogenic shock with blood pressure < 90 mmHg, without left ventricular outflow tract obstruction mechanical circulating support could be in case of cardiogenic considered (Figure 1). shock with blood pressure < 90 mmHg, without left ventricular outflow tract obstruction mechanical circulating support could be considered (Figure 1)
Summary
The reported incidence of cardiogenic shock (CS) in TTS ranges from 6% to 20% [10,11,12]. TTS patients treated with i.v. catecholamine may show highly compromised circulation and cardiac function, poorer in-hospital outcomes, and higher long-term mortality rates in comparison to patients not receiving any form of catecholamine support [14]. It has to be taken into account that these data are derived from nonrandomized studies. Med. 2021, 10, 468 absence of left ventricular outflow tract obstruction, levosimendan infusion may 3 ofbe considered; in case of cardiogenic shock with blood pressure < 90 mmHg, without left ventricular outflow tract obstruction mechanical circulating support could be in case of cardiogenic considered (Figure 1).
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