Exploring the Role of Psychological Stress in Takotsubo Cardiomyopathy A.K.A Broken-Heart Syndrome

This comprehensive review delves into the multifaceted aspects of Takotsubo Cardiomyopathy (TCM), commonly known as Broken Heart Syndrome, exploring its intricate connection with psychological stress. Beginning with an introduction and historical context, the discussion progresses to elucidate the significance of understanding the link between psychological stress and TCM, emphasizing its impact on symptomatology, quality of life, treatment approaches, and psychological well-being. Further, the review unravels the underlying mechanisms and complex pathophysiology of TCM, categorizing its triggers and stressors while exploring the intricate relationship between psychological stress and TCM onset. Additionally, it discusses the implications of war-related stressors on TCM development, underscoring the need for effective stress management strategies tailored to individuals with TCM. Overall, this review offers a comprehensive exploration of TCM, shedding light on its nuanced relationship with psychological stress and advocating for tailored treatment approaches to address the unique needs of affected individuals.

• Predisposing Factors: Despite the absence of coronary artery disease, patients with TCM often exhibit a high prevalence of cardiovascular risk factors, such as obesity, smoking, and underlying conditions like hypertension, dyslipidemia, and diabetes.Additionally, comorbidities such as psychological disorders, pulmonary diseases, malignancies, neurologic diseases, chronic kidney disease, and thyroid diseases are commonly observed, mirroring frequencies seen in patients with acute myocardial infarction.
• Role of Stressors: Sudden somatic or emotional stress triggers a surge in catecholamine levels, leading to transient left ventricular dysfunction.Stressors can be classified into physical and emotional categories, with a diverse range of triggering events documented.Studies have shown that approximately 39% of TCM cases are preceded by emotional stressors, while 35% are associated with physical stressors.Examples of physical stressors include vigorous exercise, hyperthyroidism, alcohol or opiate withdrawal, and postoperative pain.Recent research has also linked TCM to medical conditions such as ischemic stroke, subarachnoid hemorrhage, and epileptic seizures, with cerebrovascular accidents correlating to a tenfold increased likelihood of TCM development.Emotional stressors encompass a broad spectrum, including grief, receiving bad news, fear, change in residence, anger, relationship discord, financial troubles, and bullying.The significant role of acute emotional stress in triggering TCM led to the alternative names "Stress-Induced Cardiomyopathy" and "Broken Heart Syndrome." • Pathogenic Mechanisms: The etiology of Takotsubo Cardiomyopathy (TCM) can be understood through cardiovascular and neuropsychiatric mechanisms -Cardiovascular Mechanisms: In the cardiovascular realm, several hypotheses have been proposed, categorized into vascular, myocardial, or combined mechanisms.Vascular theories suggest that TCM may result from acute coronary spasms affecting multiple vessels, spontaneous recanalization following aborted myocardial infarction, or increased ventricular afterload.Studies have shown multivessel coronary vasospasms in 5-10% of cases spontaneously and in 28% when provoked.However, the role of dobutamine (a vasodilator) and epinephrine (with coronary vasodilatory effects) in inducing TCM raises questions about pure vascular hypotheses.Increased afterload, often due to hypertension, is another proposed vascular mechanism leading to TCM.Within the myocardial realm, acute left ventricular outflow tract obstruction (LVOTO) and direct catecholamine-mediated myocardial stunning are considered.LVOTO can compromise forward stroke volume, leading to symptoms typical of TCM, such as hypotension or cardiogenic shock.Approximately 25% of TCM cases manifest LVOTO, with risk factors including small left ventricle or localized sigmoid septum.However, LVOTO alone cannot explain certain patterns seen in TCM, indicating it may be a complication rather than a primary cause.
-Neuropsychiatry and TCM: TCM is thought to be influenced by various psychiatric and neurological conditions due to its close association with organs like the brain.Depression and chronic stress have been linked to anatomical changes in the brain, including decreased hippocampal volume and gray matter loss, along with alterations in the HPA axis response to stress.Women with TCM often have a history of chronic anxiety disorders preceding the event.Studies suggest that individuals with anxiety and mood disorders are more susceptible to TCm due to increased likelihood of stressful occurrences.This underscores the intertwined nature of mental and physical health in TCM.Recent reviews further support the association between chronic stress, depression, and TCM susceptibility.Underlying psychiatric disorders or their exacerbation can heighten susceptibility to TCM when faced with significant emotional or physical stressors.
Exploring Possible Triggers and Stressors Associated with TCM Some theories suggest that Takotsubo Cardiomyopathy (TCM) could arise from a temporary spasm of the coronary arteries, while others propose that reduced blood flow to the heart's smaller blood vessels might be a triggering factor.Additionally, an excessive release of stress hormones, particularly adrenaline, is also believed to contribute to its onset.
Intense emotions such as grief, fear, or sadness are commonly associated with triggering TCM, which has earned it the nickname "broken heart syndrome."TCM may also be precipitated by sudden illnesses, including: -Accidental overdose of adrenaline -Presence of an adrenaline-producing tumor -Asthma exacerbations -Chemotherapy treatment -Bereavement or loss of a loved one -Experience of domestic abuse -Significant financial setbacks -Exposure to natural disasters -Surgical procedures However, in some instances, there may not be a clear identifiable cause for the occurrence of TCM.Recent research has also examined the association between war-related stressors and the severity of coronary artery disease, particularly among Syrian refugees.Notably, crossing "green-lines," the border between warring factions, was strongly correlated with more complex coronary artery disease presentations.

Exploring the
Wars induce abnormal surges in circulating catecholamines, a crucial trigger for TCM development.
Despite the prevalence of wars throughout history, reports of TCM cases directly related to war remain scarce.This case report illustrates the far-reaching repercussions of the Russia-Ukraine conflict, demonstrating how a patient residing far from the conflict zone experienced TCM due to the stress and anxiety stemming from the inability to contact family members in the war-affected area of Kyiv.
Patients with TCM often report long-term stress, occasionally preceded by acute stress triggers, highlighting the ongoing need for effective stress management strategies in this population.Despite efforts to cope with stress, many patients continue to experience its effects even after six months.There is a pressing demand for novel treatment options tailored to the unique needs of individuals with TCM.

Exploring Psychosocial Contributors to TCM Risk
• Emotional Stress: Takotsubo Cardiomyopathy often emerges following significant emotional or psychological stressors, such as bereavement, interpersonal conflicts, financial strain, or traumatic experiences.Elevated emotional stress levels can trigger the release of stress hormones like adrenaline, potentially impacting heart function and predisposing individuals to TCM.
• Psychological Factors: Certain psychological conditions, including anxiety, depression, and chronic stress, have been linked to heightened TCM risk.These factors can disrupt the autonomic nervous system, leading to irregular heart rhythms or alterations in heart function that increase susceptibility to TCM.
• Personality Traits: Specific personality traits, such as Type A behavior (marked by competitiveness, impatience, and hostility) or perfectionism, have been correlated with an elevated TCM risk.These traits often coincide with heightened stress levels and may contribute to TCM development in susceptible individuals.
• Social Support and Relationships: Inadequate social support or unsatisfactory relationships can foster feelings of loneliness, isolation, and chronic stress, all recognised as TCM risk factors.Conversely, robust social support networks and positive relationships may mitigate TCM risk by buffering against stress-related effects.
• Coping Strategies: Unhealthy coping mechanisms like avoidance, denial, or substance misuse can exacerbate stress and elevate TCM risk.Individuals struggling to manage stress effectively may be more susceptible to its physiological impact on cardiac health.
• Socioeconomic Factors: Socioeconomic elements such as low income, unemployment, or limited access to healthcare resources can foster chronic stress and heighten TCM risk.Disparities in healthcare accessibility and quality may further influence TCM outcomes among affected individuals.

Why "Broken Heart"?
The term "Broken Heart Syndrome" primarily stems from its association with negative emotions and their effects, hence its colloquial designation as the "Broken Heart" syndrome.However, the role of "positive emotions" in Takotsubo Cardiomyopathy (TCM) remains inadequately defined.Positive emotions and heightened happiness wield similar endocrinological potency as negative emotions, capable of influencing the autonomic nervous system and altering heart rate, peripheral vascular resistance, and blood pressure.Nevertheless, conflicting evidence exists regarding the impact of positive emotions on cardiovascular health.While positive emotions have been linked to reduced cardiovascular disease risk over time, some data suggest otherwise.Positive emotions can activate both the sympathetic and parasympathetic nervous systems.Intriguingly, individuals predisposed to TCM have a 27% higher likelihood of experiencing a cardiovascular event on their birthday, attributable to associated positive stress.Numerous cases have documented TCM occurrences following joyful or socially endorsed moments, underscoring the stressinduced nature of cardiomyopathy, which can arise from either positive or negative emotional triggers.Thus, linking TCM exclusively to negative emotions oversimplifies its etiology.A systematic analysis by Ghadri et al. compared "Broken Heart Syndrome" and "Happy Heart Syndrome," finding comparable baseline characteristics and clinical presentations, including chest pain and dyspnea, irrespective of the triggering event's nature.Moreover, the "Happy Heart" group exhibited a higher prevalence of midventricular TCM.However, "Happy Heart Syndrome" represents only a small fraction of all TCM cases, implying that pleasant events may necessitate more potent stimuli than negative emotions to elicit a significant emotional response capable of precipitating TCM.Consequently, the cardiovascular system's threshold for influence may be higher when processing positive experiences.

Comparison Between Takotsubo Cardiomyopathy and Heart Attack
Takotsubo cardiomyopathy can result in severe yet reversible weakness of the heart muscle or symptoms resembling heart failure.This condition may mimic a heart attack, displaying symptoms like chest pain, breathlessness, and occasionally disturbances in heart rhythm.However, unlike a heart attack, Takotsubo cardiomyopathy typically does not stem from obstructed arteries in the heart.Rather, it is believed to be triggered by a surge in stress hormones that temporarily disrupt the heart's usual pumping function.Broken heart syndrome is often precipitated by intense emotional stress, such as the loss of a loved one, a relationship breakup, or significant financial setbacks.Conversely, a heart attack, also referred to as a myocardial infarction, occurs when blood flow to a segment of the heart is obstructed for an extended period, resulting in damage or death of heart muscle tissue.This blockage generally arises from plaque buildup within the coronary arteries, which can rupture and create a blood clot, impeding blood flow to the heart.Heart attacks typically manifest with symptoms such as chest discomfort, breathlessness, nausea, dizziness, and perspiration.Unlike broken heart syndrome, a heart attack is usually triggered by underlying cardiovascular disease and necessitates immediate medical intervention to minimize heart muscle damage.

Overview of Current Diagnostic Criteria and Techniques for Detecting TCM
Diagnosing Takotsubo cardiomyopathy (TCM) involves a comprehensive approach integrating clinical assessment, imaging modalities, and the exclusion of alternative cardiac pathologies.Here are the current diagnostic criteria and methods utilized for identifying TCM: • Clinical Presentation: Patients typically manifest with acute chest discomfort, breathlessness, and other symptoms reminiscent of a heart attack.A history of antecedent emotional or physical stressors is often noted, although not universally present.
• Electrocardiogram (ECG): ECG manifestations may resemble those observed in a heart attack, including ST-segment deviations, T-wave inversions, or QT interval prolongation.Notably, ECG changes in TCM tend to be transient and dynamic, contrasting with the more stable alterations seen in a typical myocardial infarction.
• Cardiac Biomarkers: Elevations in cardiac biomarkers such as troponin may indicate myocardial injury, albeit typically of lesser magnitude compared to conventional heart attacks.
• Echocardiography: Transthoracic echocardiography (TTE) serves as a pivotal imaging modality for TCM diagnosis.Characteristic findings include transient wall motion abnormalities not conforming to a specific coronary artery territory.Predominantly, the left ventricular (LV) apex displays involvement, resulting in the distinctive "apical ballooning" appearance.However, other LV segments, as well as mid-ventricular or basal segments, may also exhibit abnormalities.Echocardiography aids in discriminating TCM from alternative cardiac pathologies such as myocardial infarction with apical involvement or myocarditis.
• Coronary Angiography: This diagnostic procedure is commonly employed to exclude obstructive coronary artery disease, which may mimic TCM.In TCM cases, coronary angiography typically reveals either the absence of significant obstructive lesions or only mild non-obstructive disease, underscoring the diagnostic hallmark of TCM.
• Cardiac MRI: Utilization of cardiac MRI allows for further assessment of myocardial function and tissue characterization.It offers valuable insights into the extent and distribution of myocardial involvement, aiding in the differentiation of TCM from other cardiac conditions.

Discussion on Challenges and Progress in TCM Diagnosis
Diagnosing Takotsubo Cardiomyopathy (TCM) poses several challenges, including: Differential Diagnosis: Distinguishing TCM from other cardiac conditions, notably acute coronary syndrome (ACS), presents a primary challenge.Both TCM and ACS can exhibit similar symptoms such as chest discomfort, breathlessness, and ECG alterations.However, their underlying mechanisms and treatment strategies differ significantly.Clinicians must meticulously assess clinical history, risk factors, and diagnostic findings to accurately discern between the two conditions.

Atypical Presentation:
While TCM often manifests with symptoms resembling a heart attack, it can also present atypically, potentially delaying diagnosis or leading to misdiagnosis.Some patients may present with non-specific symptoms like dyspnea, syncope, or neurological manifestations without classic chest pain.This complicates the diagnostic process, especially when TCM is not initially considered in the differential diagnosis.

Overlap with Other Conditions:
TCM may coexist with various medical conditions, further complicating diagnosis.Patients with TCM may have underlying psychiatric, respiratory, or endocrine disorders that contribute to their clinical presentation.Untangling these comorbidities' influences on the overall clinical picture requires thorough evaluation and comprehensive assessment.

Limitations of Diagnostic Tests:
While echocardiography is pivotal in TCM diagnosis, its availability and interpretation may pose challenges, especially in resource-constrained settings or with limited expertise in cardiac imaging.Additionally, cardiac biomarkers like troponin, commonly used in ACS diagnosis, may not always provide conclusive evidence of myocardial injury in TCM, leading to diagnostic uncertainty.

Variability in Presentation:
TCM exhibits a broad spectrum of clinical presentations and severity, ranging from mild symptoms to severe cardiac dysfunction and complications.This variability complicates establishing uniform diagnostic criteria and underscores the importance of personalized patient evaluation and management.

Advancements in TCM Diagnosis: Increased Awareness:
Growing recognition of TCM among healthcare professionals has enhanced awareness of its clinical features and diagnostic criteria, facilitating earlier identification and management.

Refinement of Diagnostic Criteria:
Evolution of diagnostic criteria, such as the International Takotsubo Diagnostic Criteria (InterTAK Diagnostic Criteria), has standardized TCM diagnosis, aiding differentiation from other cardiac conditions and ensuring consistent evaluation across clinical settings.

Advanced Imaging Techniques:
Advancements in imaging, including three-dimensional echocardiography and strain imaging, have improved the sensitivity and accuracy of detecting subtle myocardial abnormalities associated with TCM.

Biomarkers and Diagnostic Tests:
Research into TS-specific biomarkers, such as copeptin and natriuretic peptides, has provided insights into myocardial injury and neurohormonal activation, aiding in diagnosis and risk stratification.

Multimodal Diagnostic Approach:
A comprehensive diagnostic approach integrating clinical evaluation, ECG monitoring, biomarker assessment, and imaging studies has become standard practice, enhancing diagnostic accuracy and patient care.

Collaborative Research Efforts:
Ongoing collaborative research endeavors focusing on TCM mechanisms, risk factors, and outcomes have driven diagnostic advancements, leveraging large datasets, meta-analyses, and multicenter studies to enhance understanding and management of TCM.

Overview of Current Treatment Options for TCM
The management of Takotsubo Cardiomyopathy primarily revolves around conservative measures aimed at alleviating emotional or physical stress.However, in cases where acute complications such as heart failure and shock arise, intensive interventions become necessary.The treatment approach for heart failure and shock aligns with general guidelines for their management in non-TCM cases, with exceptions in instances of left ventricular outflow tract obstruction (LVOTO).Caution is warranted in preventing volume depletion or using vasodilatory medications in LVOTO cases.Typically, the duration of TCM treatment spans from three months to one year based on expert opinion.Nonetheless, a study conducted by Fazio et al. revealed that TCM treatment exceeding three months did not significantly impact survival and should thus be avoided.The management of TCM can be categorized into two groups: TCM without complications and TCM with complications.The latter includes hypotension and cardiogenic shock with heart failure or LVOTO, cardiac arrhythmias, and thromboembolism.

TCM with Complications -Hypotension and Cardiogenic Shock:
Continuous monitoring of clinical parameters is essential for TCM patients with hypotension or shock.In up to 5%-10% of cases, patients can develop cardiogenic shock, necessitating careful management.Urgent echocardiography should be conducted to assess for LVOTO and rule out mitral valve abnormalities.Treatment varies based on LVOTO presence: Cardiogenic shock without LVOTO: Fluid resuscitation may be considered, along with cautious use of inotropic agents in patients with LV systolic dysfunction but without LVOTO.However, in cases of moderate to severe LVOTO, inotropic agents are contraindicated.Patients with persistent hypotension or signs of end-organ damage may require pulmonary catheterization/wedge pressure monitoring and intraaortic balloon pumps (IABP).Cardiogenic shock with LVOTO: Inotropic agents should be avoided due to their potential to exacerbate LVOTO.Instead, fluid resuscitation and beta-blockers can be beneficial.In severe cases, alpha agonists such as phenylephrine may help increase after-load.Extracorporeal membrane oxygenation can be considered as a life-saving alternative for circulatory support.

TCM with Complications -Heart Failure:
Acute heart failure in TCM is managed similarly to heart failure from other causes, but preload and afterload reduction therapies should be avoided in LVOTO cases.Standard HF medications like diuretics, ACE inhibitors, or ARBs can be prescribed.Beta-blockers may not lower mortality in TCM-related HF but can reduce cardiac rupture incidence.The duration of treatment typically lasts four weeks until systolic function improves.Levosimendan has shown promise in improving left ventricular ejection fraction and has a good safety profile.

TCM with Complications -Thromboembolism:
Ventricular thrombus risk should be evaluated by echocardiography in TCM patients with severe LV dysfunction.Early anticoagulation with heparin followed by warfarin for three months can prevent stroke in these patients.Anticoagulation for three months is recommended in patients with severe LV dysfunction or LV thrombus to prevent systemic embolization.In summary, TCM management requires a tailored approach based on the presence of complications, emphasizing meticulous monitoring and prompt intervention to mitigate adverse outcomes.

Exploration of Personalized Approaches to TCM Treatment Based on Stress Profiles
• Psychosocial Evaluation: Conducting a thorough psychosocial assessment to identify specific stressors or emotional triggers contributing to TCM.This assessment may involve examining recent life events, coping mechanisms, and emotional health.
• Stress Management Strategies: Implementing personalized stress management techniques tailored to individual stress profiles.This may include mindfulness-based stress reduction, cognitive-behavioural therapy, relaxation techniques, or stress-reducing activities such as yoga or meditation.
• Psychological Support: Offering psychological support and counselling to assist individuals in coping with stressors, processing emotions, and developing healthier coping strategies.Addressing underlying anxiety, depression, or other mental health concerns is essential in TCM treatment.
• Lifestyle Adjustments: Recommending lifestyle modifications to alleviate stress levels and promote cardiovascular health.This could involve regular exercise, balanced nutrition, sufficient sleep, smoking cessation, and limiting alcohol consumption.
• Medication Administration: Prescribing medications to manage symptoms and address underlying cardiovascular risk factors.This may include beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, or other medications to regulate blood pressure and prevent further cardiac complications.
• Personalized Cardiac Rehabilitation: Creating customized cardiac rehabilitation programs that focus on physical activity, education, and lifestyle adjustments tailored to individual needs and stress profiles.This might include supervised exercise sessions, dietary guidance, and ongoing support.
• Regular Monitoring and Follow-up: Close monitoring of individuals with TCM for potential recurrent episodes, cardiac function, and psychological well-being.Adjustments to treatment plans may be necessary based on individual responses and changes in stress levels over time.
• Multidisciplinary Healthcare Team: Collaborating with a multidisciplinary team of healthcare professionals, including cardiologists, psychologists, nurses, and rehabilitation specialists, to deliver comprehensive and coordinated care for individuals with TCM.

Proposal for Potential Research Areas on TCM and Psychological Stress
• Mechanisms of Stress-Induced Cardiomyopathy: Investigating the specific physiological and biochemical mechanisms that lead to TCM in response to psychological stress.This research may focus on understanding the roles of catecholamines, neurohormonal pathways, inflammation, and genetic predispositions.
• Psychosocial Risk Factors: Identifying and examining the psychosocial factors contributing to TCM development, including major life events, chronic stress, social isolation, depression, anxiety, and personality traits.Understanding how these factors interact and affect cardiac function could offer valuable insights.
• Gender Differences: Exploring potential gender disparities in TCM prevalence, presentation, and outcomes related to psychological stress.This research could delve into hormonal influences, genderspecific stressors, and coping mechanisms.
• Neurological and Psychiatric Comorbidities: Investigating the relationship between TCM and neurological or psychiatric disorders associated with stress, such as PTSD, anxiety disorders, and mood disorders.Understanding these connections could inform clinical management and psychological interventions.
• Long-Term Outcomes and Prognostic Factors: Conducting longitudinal studies to assess the longterm outcomes of TCM patients who experience psychological stressors.Identifying prognostic factors linked to recurrence, mortality, and cardiovascular events could guide risk assessment and tailored treatments.
• Psychological Interventions and Coping Strategies: Evaluating the effectiveness of psychological interventions and coping strategies in preventing TCM recurrence, enhancing quality of life, and reducing psychological distress.This may include mindfulness-based interventions, cognitivebehavioural therapy, and social support programs.
• Impact of COVID-19 Pandemic: Investigating the impact of the COVID-19 pandemic on TCM incidence, clinical characteristics, and outcomes concerning psychological stress.This crisis introduces unique stressors, such as infection fears and economic uncertainty, which may affect cardiac health.
• Biomarkers and Imaging Techniques: Exploring novel biomarkers and imaging methods to aid in early TCM diagnosis, risk assessment, and monitoring in individuals experiencing psychological stress.This could involve assessing cardiac biomarkers, advanced imaging techniques, and molecular imaging.
• Animal Models and Experimental Studies: Utilizing animal models and experimental approaches to elucidate the pathophysiological mechanisms linking psychological stress to TCM.Manipulating stressors in animal models and studying changes in cardiac structure, function, and gene expression may provide valuable insights.
• Multidisciplinary Approaches: Encouraging multidisciplinary collaboration among cardiologists, psychologists, psychiatrists, neuroscientists, and other relevant disciplines to comprehensively address the complex relationship between psychological stress and TCM.Integrated approaches considering both cardiac and psychological factors are crucial for advancing our understanding and management of this syndrome.

Conclusion
In conclusion, the exploration of Takotsubo cardiomyopathy (TCM) in the context of psychological stress unveils a multifaceted relationship between the mind and the heart, challenging traditional notions of cardiovascular pathophysiology.Through extensive investigation into the mechanisms, risk factors, outcomes, and therapeutic strategies associated with TCM, researchers have uncovered a complex interplay of physiological, psychological, and social factors that contribute to the onset and progression of this enigmatic condition.The elucidation of TCM as a stress-induced cardiomyopathy has revolutionized our understanding of acute cardiac events, highlighting the profound impact of emotional and psychological stressors on cardiac function.From the surge of catecholamines to the dysregulation of neurohormonal pathways, numerous mechanisms have been proposed to explain the pathogenesis of TCM, emphasizing the intricate web of interactions between the brain, the autonomic nervous system, and the myocardium.Moreover, the identification of psychosocial risk factors, such as major life events, chronic stress, and psychiatric comorbidities, underscores the importance of addressing psychological well-being in the assessment and management of TCM patients.Longitudinal studies have provided valuable insights into the prognostic significance of these factors, guiding risk stratification and personalized treatment approaches aimed at optimizing patient outcomes.Moving forward, the field of TCM research stands at the forefront of interdisciplinary collaboration, inviting cardiologists, psychologists, neuroscientists, and other experts to unite in a concerted effort to unravel the complexities of this syndrome.By embracing innovative methodologies, including advanced imaging techniques, experimental models, and psychosocial interventions, researchers can further advance our understanding of TCM and pave the way for targeted therapies tailored to the individual needs of affected patients.
In essence, the study of Takotsubo syndrome in the context of psychological stress represents a pivotal frontier in cardiovascular medicine, offering not only new insights into the pathophysiology of acute cardiac events but also novel avenues for holistic patient care that integrate the principles of both cardiology and psychiatry.As we continue to unravel the mysteries of TCM, let us remain steadfast in our commitment to improving the lives of those affected by this unique and intriguing syndrome.

Relationship Between Psychological Stress and the Onset of Takotsubo Syndrome TCM
with evidence suggesting potential cardiovascular consequences.Studies have linked PTSD to an increased risk of coronary artery disease, as well as a higher incidence of ventricular tachy-arrhythmias following stressful events such as the 9/11 attack in New York City.
represents a well-established form of acute and reversible left ventricular dysfunction triggered by a significant surge in catecholamines within the body.This surge typically follows Complications: Patients who are hemodynamically stable without signs of complications like acute heart failure, arrhythmia, or thromboembolism should be admitted to cardiology for further monitoring.Studies by Yeyehd et al. demonstrated that dual anti-platelet therapy (DAPT), including aspirin and clopidogrel, anticoagulation, beta-blockers, statins, angiotensin-converting enzyme (ACE) inhibitors/angiotensin receptor blockers (ARBs), and psychological stress relief management contributed to reduced inpatient mortality and TCM recurrence.Additionally, Dias et al. indicated that single anti-platelet therapy or DAPT independently decreased major adverse cardiovascular events in TCM patients.ACE inhibitors were associated with improved survival, as reported by Templin et al.A meta-analysis by Santoro et al. suggested that aspirin, statins, beta-blockers, and ACE/ARBs did not reduce TCM recurrence.