223. A Broken Heart - An Approach to Takatsubo Cardiomyopathy

Takotsubo cardiomyopathy, commonly known as "broken heart syndrome," is a transient, reversible non-ischemic cardiomyopathy characterized by regional left ventricular dysfunction and apical ballooning. Primarily affecting postmenopausal women, the condition is believed to be triggered by a massive catecholamine release during intense emotional or physical stress, which leads to myocardial stunning. Diagnosis relies on the modified Mayo Clinic criteria, requiring the exclusion of obstructive coronary disease and myocarditis through urgent angiography. Management is largely supportive, utilizing beta-blockers and ACE inhibitors during the acute recovery phase, though severe cases involving cardiogenic shock or left ventricular outflow tract obstruction require specialized hemodynamic interventions like phenylephrine or mechanical circulatory support. While often considered benign, the condition carries a 6% 30-day mortality rate and has seen a nearly five-fold increase in incidence during the COVID-19 pandemic due to heightened global psychological and physiological stressors.