Recent Progress in the Diagnosis and Management of Tako-Tsubo Syndrome

Tako-Tsubo Syndrome (TTS), also known as apical ballooning syndrome or “broken heart syndrome”, was discovered by Japanese investigators 27 years ago, and was initially assumed to be a rarity. However, TTS is relatively common, especially among ageing women and in the setting of severe physical/emotional stress. TTS represents an aberrant β2-adrenoceptor mediated myocardial inflammatory response to catecholamine stimulation, most commonly seen in the ageing female heart. It remains under-diagnosed in most hospitals. Initially, TTS was essentially a diagnosis of exclusion, typically made after emergency coronary angiography in patients presenting with ST segment elevation who had no relevant coronary artery disease. However, at least 50% of patients with TTS never show ST elevation. We therefore propose a diagnostic algorithm for (a) Initial tentative diagnosis (b) Definitive positive diagnosis (i.e. not by exclusion) (c) Quantitation of severity of attacks of TTS, Which should expedite the avoidance of catecholamine administration to these patients. Key aspects to consider are: 1. Clinical presentation (including demographics and prior circumstances).