The Neuro-Cardiac Axis: Cellular and Systemic Consequences of Acute Stress in Takotsubo Syndrome

Takotsubo syndrome (TTS), often called “broken heart syndrome,” is an acute and usually reversible form of left ventricular dysfunction that mimics acute coronary syndrome but is not explained by an obstructive coronary lesion [1,2]. It is preceded by an emotional or physical trigger in many, but not all, patients and predominantly affects postmenopausal women [2]. This narrative review synthesizes current understanding of the epidemiology, proposed cellular and systemic mechanisms, brain–heart interactions, diagnosis, clinical course, and management of TTS. Particular emphasis is placed on the catecholamine surge and sympathetic activation thought to link stress to myocardial dysfunction, and on the contributions of receptor-level signaling, microvascular dysfunction, inflammation, and altered limbic and autonomic brain networks. Seven tables and four figures summarize registry data, proposed mechanisms, neuroimaging findings, diagnostic tools, management, and practical nursing considerations. Many mechanistic details remain hypotheses rather than established facts, no treatment has been proven to improve outcomes in randomized trials, and the evidence for psychological interventions is limited. The review is non-systematic and is intended as an accessible synthesis for students and early-career clinicians.