Treatment of Takotsubo Cardiomyopathy

Takotsubo cardiomyopathy (TC) is a condition most prevalent in postmenopausal women, characterized by transient left ventricular dysfunction following acute emotional or physical stress. Direct catecholamine-mediated myocyte injury and microvascular dysfunction leading to myocardial stunning are believed to play a major role in its pathogenesis. The treatment of TC remains empirical. In the acute phase, therapy must be individualized depending on hemodynamic situation. In stable conditions, it appears advantageous to prevent excessive sympathetic activation by combining alpha and beta blockade. Beta blockers are used to treat dynamic left ventricular obstruction. Phenylephrine may represent an alternative approach in patients presenting with outflow tract obstruction and severe hypotension. In hemodynamically unstable patients, early administration of intra-aortic balloon pump counterpulsation should be considered. As no consensus currently exists with respect to the chronic management of TC, randomized clinical trials are urgently needed with focus on treatment strategies.