Fuzzy boundaries between physical and emotional triggers in Takotsubo syndrome: a scoping review

Takotsubo Syndrome (TTS) is a cardiac condition that mimics myocardial infarction, often in the absence of obstructive coronary disease. TTS is typically described as triggered by stressful/traumatic events, which are often categorized as either emotional/psychosocial or physical; nevertheless, emerging evidence suggests that this stark classification may be limiting. We hypothesize that, in most cases, clinicians may overlook possible physical and emotional components or concurrent intense emotional experiences of physical TTS triggers during patients’ assessment. We searched through four databases for clinical case reports of TTS patients with clearly identified antecedents that may have elicited the cardiac event. After a thorough study selection, 219 studies were included in the final scoping review and a total of 259 cases were presented, 210 of which were female. Most of the studies reported in selected literature described physical stressors (n = 135) as triggers of TTS, while 38 reported emotional triggers; in 45 case studies, both physical and affective stressors were present. Most physical triggers may have an emotional side that seems to be overlooked by physicians; we thus propose a new perspective where the boundaries between physical and emotional stressors in TTS may be fuzzy, promoting the role of clinical psychology in cardiological settings.