Cancer-Associated Takotsubo Syndrome: An Emerging Intersection of Cardio-Oncology

Takotsubo syndrome (TTS) is an acute stress-induced cardiomyopathy that mimics acute coronary syndrome and is recognized in patients with malignancy. Outcomes analyses and contemporary cardio-oncology reviews further emphasize malignancy as a clinically meaningful modifier of TTS risk, phenotype, and prognosis. Cancer patients represent a uniquely vulnerable population due to the combined effects of emotional stress, systemic inflammation, autonomic imbalance, and exposure to potentially cardiotoxic therapies. Targeted anticancer agents that perturb vascular homeostasis (eg, vascular endothelial growth factor-pathway inhibition) also contribute to endothelial dysfunction, hypertension, thromboinflammation, and myocardial stress—mechanisms that plausibly lower the threshold for stress cardiomyopathy in susceptible patients. Evidence suggests that TTS in the oncology setting is associated with higher complication rates, increased mortality, and complex diagnostic and management challenges compared with noncancer populations. Large-scale database studies and propensity-matched real-world analyses reinforce the need for cancer-specific risk stratification and tailored cardiovascular management pathways. Moreover, cancer-associated TTS often occurs at critical junctures, including at diagnosis, during active treatment, or in the perioperative period, and may reflect underlying disease severity or physiological frailty. This review explores the epidemiology, pathophysiological mechanisms, and clinical presentation of TTS in patients with cancer, with particular emphasis on neurohormonal activation, inflammatory pathways, endothelial dysfunction, and treatment-related triggers.