Therapeutic Strategies for Takotsubo Syndrome: A Comprehensive Clinical Review

Takotsubo syndrome (TTS), also known as stress-induced cardiomyopathy, is an acute reversible form of left ventricular systolic dysfunction that mimics acute coronary syndrome in presentation. Once regarded as benign, TTS is now recognized to have a complicated in-hospital course in a substantial proportion of patients, with clinically significant events occurring in up to one third of cases, including cardiogenic shock, arrhythmias, thromboembolism, and death. Despite growing recognition, evidence-based management strategies remain limited due to the absence of randomized controlled trials. However, early evidence from small randomized trials is emerging in support of nonpharmacological interventions. This review provides a comprehensive synthesis of current therapeutic strategies for acute and long-term management of TTS, including pharmacological and nonpharmacological interventions such as cardiac rehabilitation, and management of psychiatric (eg, anxiety, depression) comorbidities, which increase the incidence of recurrences. As of today, TTS management remains largely empirical, relying on expert consensus and registry data focused on a multidisciplinary, personalized approach integrating cardiovascular, neurological, and psychological domains. Clinical trials and mechanistic research are needed to establish evidence-based therapies targeting the unique pathophysiology of TTS.