What initial management strategies should be implemented for a patient diagnosed with Takotsubo cardiomyopathy?

Initial management strategies for a patient diagnosed with Takotsubo cardiomyopathy often begin with treatment for acute coronary syndrome (ACS) due to similar presenting symptoms, including chest pain, dyspnoea, and changes on electrocardiogram (ECG) and cardiac biomarkers NICE NG185, Assad et al. 2022, Singh et al. 2022. Once Takotsubo cardiomyopathy is confirmed, management is primarily supportive and focuses on symptom control and preventing complications Assad et al. 2022, Singh et al. 2022.

• Close monitoring is essential for potential complications such as arrhythmias, heart failure, and cardiogenic shock Assad et al. 2022.
• Pharmacological interventions typically include:
  • Beta-blockers are often initiated, particularly if left ventricular outflow tract (LVOT) obstruction is present, to reduce sympathetic drive and improve the LVOT gradient Assad et al. 2022, Omerovic 2016.
  • Angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) are recommended for patients experiencing left ventricular dysfunction Assad et al. 2022, Omerovic 2016.
  • Diuretics may be administered to manage pulmonary congestion if present Assad et al. 2022.
  • Anticoagulation should be considered in cases of severe left ventricular dysfunction or if an apical thrombus is identified, due to the increased risk of thromboembolic events Assad et al. 2022, Omerovic 2016.
  • Drugs that release catecholamines should be avoided Omerovic 2016. Inotropes should be used with caution, especially in the presence of LVOT obstruction Assad et al. 2022.
• Addressing the trigger: Identifying and managing the underlying emotional or physical stressor is an important aspect of recovery Assad et al. 2022, Singh et al. 2022.