BROKEN HEART SYNDROME (TAKOTSUBO CARDIOMYOPATHY) AND PSYCHOLOGICAL STRESS: A NARRATIVE REVIEW

Abstract

Background: Takotsubo cardiomyopathy (TTC), also known as takotsubo syndrome (TTS) or broken heart syndrome, is an acute reversible cardiac disorder characterized by transient left ventricular dysfunction that mimics acute myocardial infarction. First described in Japan in 1990, TTS is increasingly recognized as a model of psychosomatic cardiovascular disease. However, the mechanisms linking psychological stress with myocardial dysfunction remain incompletely understood. Objectives: This narrative review summarizes current evidence on the relationship between psychological stress and the onset, clinical course, and prognosis of TTS, with emphasis on neuroendocrine and autonomic mechanisms. Methods: A structured literature search was conducted across PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar, covering publications from 1990 to 2025, including original research, reviews, meta-analyses, and guidelines addressing psychological stress, neuroendocrine pathways, and psychiatric comorbidities in TTS. Results: Acute stress triggers a catecholamine surge two- to threefold higher than in myocardial infarction, causing sympathetic overstimulation and cardiomyocyte toxicity. Apical vulnerability reflects increased β2-receptor density, while hypothalamic-pituitary-adrenal (HPA) axis activation may enhance adrenergic sensitivity via cortisol. Anxiety and depression affect up to 56% and 48% of patients, respectively. Women, particularly postmenopausal, account for over 90% of cases and appear especially vulnerable due to estrogen-related alterations in sympathoadrenal regulation. Conclusions: TTS represents a psychosomatic cardiovascular syndrome in which emotional stress manifests as acute cardiac dysfunction. Integrated psychocardiac management combining cardiac care, psychiatric assessment, and psychological support may improve outcomes and reduce recurrence risk.