Takotsubo syndrome: management strategies

Takotsubo syndrome (TS) management is a complex task that requires a comprehensive and differentiated approach, taking into account various clinical scenarios and potential complications. This review analyses current strategies for TS management, covering the treatment of uncomplicated cases, management of lifethreatening complications, and assessment of longterm prognosis. In uncomplicated cases, the primary treatment goal is to stabilise the patient’s condition and relieve symptoms. Firstline medications typically include betablockers and angiotensinconverting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs). While the role of betablockers remains a subject of debate within the scientific community, ACEIs/ARBs have shown promising results in improving longterm prognosis and reducing the likelihood of recurrences. Management of patients with complicated forms of TS, particularly cardiogenic shock and intraventricular thrombosis, requires more aggressive therapeutic interventions. In cases of cardiogenic shock, it is crucial to differentiate whether left ventricular outflow tract obstruction is present, as this determines the choice of optimal inotropic support. The detection of intracardiac thrombus is an indication for anticoagulant therapy, with a recommended duration of at least three months or until full recovery of myocardial contractility. Although the overall prognosis for TS is generally favourable, with a high probability of left ventricular dysfunction regression, the risk of disease recurrence persists. To optimise longterm patient management, it is advisable to conduct not only regular monitoring of left ventricular function but also assessment of the patient’s psychoemotional state. However, the lack of conclusive evidence regarding the effectiveness of longterm pharmacological therapy in preventing disease recurrence underscores the need for further largescale studies.

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