Takotsubo syndrome complicated by ventricular arrhythmias vs. Ventricular arrhythmias triggering Takotsubo syndrome

The present review focuses on the thesis that there is an amphidromic relationship between ventricular arrhythmias (VA) and takotsubo syndrome (TTS), with VA emerging as complications of TTS, and TTS being precipitated by VA with or without culmination in cardiac arrest (CA). The mechanism(s) of these phenomena is(are) being explored, and the emerging diagnostic possibilities are outlined. Emphasis is made on the need to upgrade our current approach in diagnosis TTS, and its occasional presence as a "TTS component", in association with other cardiovascular and other comorbidities. The diagnosis and management of various emerging TTS subtypes, with preceding or following VA/CA is outlined, the various established or possible phenotypes are presented, and ways to confirm their pathophysiologic trajectories are offered.