Title : The neuro-cardiac axis: Cellular and systemic consequences of acute stress in Takotsubo syndrome: A narrative review of stress-induced cardiomyopathy
Abstract:
Takotsubo syndrome (TTS), often called "broken heart syndrome," is an acute and usually reversible form of left ventricular dysfunction that mimics acute coronary syndrome but is not explained by an obstructive coronary lesion. It often follows emotional or physical stress, although some patients have no evident trigger, and it mainly affects postmenopausal women. In the International Takotsubo Registry, 89.8% of patients were women, in-hospital mortality was about 4%, and long-term major adverse event rates were 9.9% per patient-year, showing that TTS is not uniformly benign.
This narrative review summarizes current knowledge on the epidemiology, triggers, proposed mechanisms, brain-heart interactions, diagnosis, clinical course, and management of TTS. A catecholamine surge and sympathetic activation are considered central mechanisms linking acute stress to myocardial dysfunction. Proposed contributors include altered beta-adrenergic receptor signaling, coronary microvascular dysfunction, calcium overload, oxidative stress, and inflammation. Neuroimaging studies suggest altered activity and connectivity in limbic and autonomic brain regions, which supports a brain-heart axis, although it remains unclear whether these changes are a cause or a consequence of the syndrome.
Diagnosis relies on integrating clinical, electrocardiographic, imaging, and angiographic findings, and the InterTAK Diagnostic Score can help estimate the likelihood of TTS. Management is mainly supportive, and no treatment has been proven to improve outcomes in randomized trials. Practical implications for nursing care include early recognition of possible acute coronary syndrome, rhythm and hemodynamic monitoring, medication safety, patient education, and psychological support.
Many mechanistic details remain hypotheses, and most evidence comes from observational and experimental studies. Prospective neuroimaging, biomarker, and interventional studies are needed. This review is non-systematic and is intended as an accessible synthesis for students and early-career clinicians.
A preprint of the full review is available at DOI: 10.20944/preprints202610.0935.v1. Generative AI (Claude) was used to help draft this abstract.
