Takostubo syndrome: A mind-body response to stress

BACKGROUND: Takostubo Syndrome (TTS) is a unique form of heart dysfunction usually proceeded by an experience of intense stress. This unusual cardiac abnormality is a remarkable example of the mind-body connection and the intricate functioning of the autonomic nervous system. Despite global research and increased recognition of TTS, the exact cause and subsequent clinical diagnosis and treatment guidelines remain lacking OBJECTIVES: Due to evolving knowledge, this review aims to present a current state of the science overview of TTS. The most current evidence on prevalence, risks, recognition, diagnosis and treatment for TTS is introduced and synthesized. While a holistic approach that recognizes mind-body interconnectedness in TTS supports the discussion of mind-body therapies that could benefit patients in recovery and rehabilitation. METHODS: Literature searches were conducted in the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and PubMed and EBSCO Host interfaces to MEDLINE. Resources were searched using terms, Takostubo cardiomyopathy, broken-heart syndrome, acute stress and mind-body cardiac event. Limitations for English language, peer-review articles published within the past 5-year was applied initially, then publication date was extended to 10-years. Reference lists of identified articles were examined for additional key studies and publications. RESULTS: Expansion of the literature search provided a dynamic understanding of TTS as a stress-induced cardiac phenomenon that most commonly affects women in their later years following an major emotional trigger. Natural disasters and physical episodes of stress can also trigger TTS. The result is damage to the cardiomyocytes due to the overstimulation of the autonomic sympathetic nervous system. This stunning of the heart produces signs and symptoms very similar to cardiac ischemia. Yet, a diagnostic cardiac work-up reveal a misshapen left apical area but no ischemia. Research is continuing provide insights to delineate the best treatment options for TTS patients. A flexible holistic approach to all aspects of evaluating, diagnosing and managing TTS patients is recommended. CONCLUSION: TTS is complex cardiac phenomenon that exemplifies the mind-body-heart interconnectedness. For the past three decades experts have been trying to decipher the specific pathophysiology underlying TTS and are attempting to develop clear evidence-based clinical treatment guidelines. However, a complete comprehension of TTS remains elusive.