Unexplored Cardiac Diseases: Takotsubo Syndrome

Takotsubo syndrome is an acute heart failure syndrome typically triggered by sudden surges in catecholamines. It predominantly affects post-menopausal women and often mimics acute coronary syndrome. A characteristic pattern of "apical ballooning" is observed, caused by reduced contractility at the left ventricular apex with relative hypercontractility at the base. Despite advances in clinical understanding, its pathophysiology remains incompletely understood, and proteomic studies are limited. Key mechanisms include catecholamine-driven negative inotropy, myocardial inflammation, altered calcium handling, mitochondrial dysfunction, and impaired coronary microvascular function. Additional susceptibility arises from chronic-stress-associated microRNAs and estrogen withdrawal post-menopause. Emerging proteomic data reveal perturbations in cardiomyocyte metabolic pathways, pro-inflammatory signaling, and cell survival cascades. This chapter integrates recent clinical, molecular, and proteomic findings to provide a contemporary understanding of Takotsubo syndrome, with a particular focus on its underlying molecular substrates.