Takotsubo syndrome: From pathophysiology to clinical practice.

Takotsubo syndrome (TTS) is an acute and transient cardiomyopathy characterised by left ventricular systolic dysfunction in the absence of obstructive coronary artery disease. Although its clinical presentation frequently resembles acute myocardial infarction, TTS is driven by distinct pathophysiological mechanisms involving sympathetic hyperactivation, catecholamine surge, coronary microvascular dysfunction, and imbalance within the brain-heart axis. Once considered a benign condition, it is now recognized to carry a significant burden of adverse events-including cardiogenic shock, malignant arrhythmias, and thromboembolic complications-with short- and long-term mortality rates comparable to those of acute coronary syndromes. Diagnosis requires the integration of clinical assessment, cardiac biomarkers, characteristic electrocardiographic changes, and advanced imaging techniques, particularly echocardiography and cardiac magnetic resonance. Management is primarily supportive and should be adapted to the predominant haemodynamic phenotype. This review provides an updated and comprehensive synthesis of the epidemiology, pathophysiology, diagnostic strategies, complications, treatment approaches, and prognosis of TTS, while highlighting current evidence gaps that warrant ongoing and future clinical trials.