Tako-Tsubo Syndrome: Issue of Incomplete Recovery and Recurrence

Tako‐Tsubo syndrome (TTS), or as previously known Tako‐Tsubo cardiomyopathy, is a form of transient LV systolic dysfunction that predominantly affects ageing women and is frequently but not always precipitated by an emotional or a physical stressor.1 A recent position statement on TTS in this journal provides a very comprehensive review of the clinical aspects of TTS along with the most recent ‘Heart Failure Association diagnostic criteria for TTS’.2 Mayo Clinic investigators proposed the initial definition of TTS in 2007.3 Since then, our understanding of TTS has significantly increased, and some important modifications have been made to the TTS diagnosis criteria by our colleagues from the Mayo Clinic, Sweden, Italy, and the European Society of Cardiology Heart Failure Association.2, 4-7 We consider TTS as a form of myocarditis where inflammation is induced by a sudden rise in catecholamine levels.1, 8 The evidence of inflammation of the myocardium in TTS has been confirmed by histological heart samples,9, 10 cardiac magnetic resonance imaging (MRI) studies,7 and by usual biochemical markers of inflammation.11 As per the recent position statement, viral myocarditis rightly remains an exclusion of TTS diagnosis. Similarly, other forms of infectious myocarditis should be excluded before making the diagnosis of TTS.