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Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.

Takotsubo cardiomyopathy

Cardiology · UK scope · Sources checked 27 Aug 2026 · Clinical review pending

RapidFull
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Escalate

Takotsubo cannot be diagnosed safely from the story or ECG alone. New chest pain, ST change, shock or malignant arrhythmia follows the emergency ACS pathway until coronary occlusion and other lethal alternatives are excluded.

Synopsis

Treat the initial ACS mimic safely, confirm transient non-coronary-pattern dysfunction and manage obstruction, shock and thromboembolism.

  • Takotsubo is transient LV and/or RV dysfunction, often beyond one coronary territory, after emotional, physical or neurological stress—but a trigger is not required.
  • It commonly affects postmenopausal women but can occur in any adult; do not use demographics to dismiss ACS.
  • ECG changes and troponin rise are common; coronary angiography is often needed because MI remains the immediate competing diagnosis.
  • Echo must look for the wall-motion pattern, LV outflow obstruction, MR, RV involvement and apical thrombus.
  • CMR helps exclude infarction and myocarditis and usually shows oedema without infarct-pattern late enhancement.
  • Shock management depends on mechanism: pump failure, dynamic LVOTO, acute MR, RV failure and arrhythmia require different treatment.
  • Apical ballooning with severe akinesis can form LV thrombus and embolise; use contrast imaging when the apex is unclear.
  • Repeat imaging should demonstrate recovery; persistent dysfunction or scar requires diagnostic reconsideration.

Key red flags

Complicated syndrome

Pulmonary oedema, shock, ventricular arrhythmia, high-grade block, RV failure or embolic signs require critical-care cardiology.

Do not miss a mimic

Dissection, pulmonary embolism, myocarditis, pheochromocytoma crisis and spontaneous coronary dissection remain important alternatives.

Investigation priorities

01
Serial ECG and high-sensitivity troponinFirst step

Run the ACS pathway and identify evolving repolarisation/QT risk.

Management branches

Front doorPossible Takotsubo

Acute chest pain/dyspnoea with ECG change or troponin rise.

  1. Activate the ACS pathway: ABCDE, ECG within 10 minutes, troponin, monitoring, aspirin if not contraindicated and immediate reperfusion assessment when indicated.
  2. Obtain urgent echo but do not use a ballooning pattern to delay coronary angiography in an unstable or STEMI-pattern presentation.
  3. Define coronary anatomy and exclude dissection, PE and myocarditis according to presentation; use CMR after stabilisation when diagnostic uncertainty remains.
  4. Once Takotsubo is established, review whether ongoing antiplatelet or statin therapy has another indication rather than continuing automatically.
RecoveryDischarge and confirmation

Stable after acute complications are controlled.

  1. Reconcile medicines to confirmed indications; there is no single proven recurrence-prevention regimen for every patient.
  2. Arrange repeat echo, usually within weeks to a few months, to demonstrate LVEF and wall-motion recovery and exclude late thrombus.
  3. Address the physical or emotional trigger without implying the illness was imagined; safety-net recurrent chest pain, syncope, breathlessness or focal neurology.

Key medicines

Aspirin300 mg orally once as soon as possible for suspected ACS, unless contraindicated; maintenance depends on the final coronary diagnosis.Active bleeding, true severe hypersensitivity and anticoagulant/bleeding context; do not let administration delay emergency reperfusion assessment.
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Sources and review status5 sources · checked 27 Aug 2026 · clinical review pending+
Sources

Sources and review status

National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.

  • NICE NG185: Acute coronary syndromesUK initial ACS assessment and aspirin treatment while MI remains possible.
  • International Expert Consensus on Takotsubo Syndrome, Part IIESC-hosted diagnostic and complication-management consensus.
  • EACVI/JSE consensus: Multimodality imaging in Takotsubo syndromeEcho, coronary CT and CMR roles.
  • 2023 ESC Guidelines for the management of cardiomyopathiesCurrent cardiomyopathy context and follow-up.
  • NHS: CardiomyopathyUK patient recognition and safety-net context.

Editorial contact: Doctor’s Passport editorial team. Source-check date is separate from clinical approval. Report a content problem · Content changes

Authoring stateRapid draftClinical stateAwaiting reviewJurisdictionUnited Kingdom