Takotsubo syndrome

Takotsubo syndrome is an acute, usually reversible clinical entity that mimics acute coronary syndrome and is characterised by transient dysfunction of the left and/or right ventricle in the absence of obstructive coronary artery disease. This scientific monograph offers a comprehensive and contemporary overview of Takotsubo syndrome from the perspective of cardiovascular physiology. It covers the historical development of the concept and nomenclature, its definition and epidemiology, with particular emphasis on pathophysiological mechanisms: intense sympathetic nervous system activity and elevated catecholamine levels, coronary microvascular dysfunction, oestrogen deficiency, nitrosative stress, inflammation, neuropsychiatric and genetic factors, and the role of microRNA. The clinical presentation and anatomical variants, complications, prognostic factors and the evolution of diagnostic criteria are examined in detail, including modern imaging and biochemical methods, as well as therapeutic strategies during hospitalisation and long-term follow-up. The second part of the monograph is devoted to animal models of the syndrome and their translational potential, together with open questions and perspectives for future research. Particular attention is given to the paradoxical ability of patients to tolerate severe ventricular dysfunction that would be fatal in the context of myocardial infarction, pointing to possible adaptive cardiovascular mechanisms. Integrating preclinical and clinical findings, the monograph is intended for medical students, researchers and clinicians as a reference resource for understanding this complex and still incompletely elucidated clinical entity.