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.
Key red flags
Pulmonary oedema, shock, ventricular arrhythmia, high-grade block, RV failure or embolic signs require critical-care cardiology.
Investigation priorities
Run the ACS pathway and identify evolving repolarisation/QT risk.
Management branches
Acute chest pain/dyspnoea with ECG change or troponin rise.
- Activate the ACS pathway: ABCDE, ECG within 10 minutes, troponin, monitoring, aspirin if not contraindicated and immediate reperfusion assessment when indicated.
- Obtain urgent echo but do not use a ballooning pattern to delay coronary angiography in an unstable or STEMI-pattern presentation.
Stable after acute complications are controlled.
Key medicines
Aspirin300 mg orally once as soon as possible for suspected ACS, unless contraindicated; maintenance depends on the final coronary diagnosis.