Group E – Mimic

Takotsubo Syndrome (TTS)

Also called “stress cardiomyopathy”. People present with chest pain, ECG changes and a rise in troponin (a blood marker of heart-muscle injury)—so it looks like a heart attack. But the large heart arteries are usually not blocked. The problem is mainly in the small vessels of the heart muscle (the microcirculation) and how the heart responds to stress hormones.

1) Symptoms & first clues

  • Sudden chest pain (often after emotional or physical stress)
  • Breathlessness; sometimes fainting
  • ECG changes (ST shift, T-wave inversion, sometimes long QT)
  • Troponin rise (usually smaller than a large heart attack but still significant)
  • Echocardiogram shows a regional movement problem of the heart muscle (often “apical ballooning”, but other patterns exist)

2) What’s happening in the heart?

A surge of stress hormones (like adrenaline) and other factors can temporarily disturb blood flow in the tiny heart vessels (microcirculation). This causes a short-term oxygen shortage (ischaemia) and the affected muscle becomes weak for a while.

Plain-English glossary

  • Microvascular dysfunction: small heart vessels don’t widen properly, so less oxygen reaches the muscle.
  • Ischaemia: the muscle isn’t getting enough oxygen for its needs.
  • Apical ballooning: the tip of the heart squeezes poorly and bulges on scan; usually recovers.

Why it mimics a heart attack

  • Similar symptoms and ECG changes
  • Raised troponin from temporary muscle injury
  • But coronary arteries are typically not blocked

3) How is it diagnosed?

Doctors first make sure there isn’t a classic blocked artery, then confirm the Takotsubo pattern:

Rule out blockage

  • Coronary angiography or CTCA to exclude major narrowings

Heart imaging

  • Echocardiogram: shows the regional movement pattern
  • Cardiac MRI (CMR): checks for swelling, scarring and blood-flow patterns

Special tests

  • In some centres, coronary physiology tests how small vessels behave
  • Clinical scores (e.g., InterTAK) can support the diagnosis

Many features improve over days to weeks, so repeat scans help track recovery.

4) Treatment

In hospital (acute care)

  • Admit and treat like a possible heart attack until confirmed otherwise
  • Oxygen and pain relief as needed
  • Support the heart if it’s struggling (diuretics for fluid, ACEi/ARB and/or beta-blocker when appropriate)
  • Monitor for rhythm problems

After discharge (longer term)

  • Most people improve within weeks; some need months
  • Medicines are supportive (help the heart while it recovers)
  • Cardiac rehab and stress-reduction strategies are helpful
  • Your team will personalise follow-up imaging and taper medicines when safe

Future directions

There’s growing interest in mechanism-based therapies that protect the small vessels. Trials are ongoing.

5) Recovery & outlook

Short-term risks can be similar to a heart attack, especially in the first days (heart failure or rhythm problems). Most people recover heart function, but a minority have lingering symptoms or recurrence. Regular follow-up and risk-factor care (blood pressure, sleep, activity, mental health) support recovery.

6) Knowledge gaps & research

  • Which medicines best prevent recurrence?
  • How to target microvascular dysfunction directly?
  • Why susceptibility is higher in post-menopausal women?

You can explore active studies on ClinicalTrials.gov. To share experiences and tips, visit our community forum.

7) Quick FAQs

  • Is it a heart attack? It behaves like one at first, but the big arteries aren’t blocked.
  • Will I get better? Most people regain heart function; keep follow-up appointments.
  • Can it come back? Yes, sometimes. Rehab, stress-management and personalised care reduce risk.