Reasons and therapy possibilities during the long-term follow-up patients with takotsubo syndrome

Takotsubo syndrome (TS) is an acute, usually reversible type of heart failure that mimics acute coronary syndrome and is often associated with stress, especially in postmenopausal women. Despite the traditional perception of TS as a benign condition, modern studies have found a significant risk of serious in-hospital complications, as well as a poor long-term prognosis. Due to the lack of randomized clinical trials and harmonized recommendations, long-term management strategies are based predominantly on observational studies and clinical experience. Objective. To analyze current approaches to the long-term treatment of patients with takotsubo syndrome based on literature data. Materials and methods. A systematic search was conducted in the PubMed database from January 1, 2010, to November 1, 2025, using the keywords «stress cardiomyopathy», «cardiomyopathy takotsubo», «broken heart syndrome», «apical ballooning syndrome», «tako-tsubo syndrome», and «transient apical ballooning syndrome». Results. Long-term management of TS is not standardized. Correction of psycho-emotional disorders (anxiety/depressive disorders were reported in 53—78% of patients) and cooperation of cardiologists and psychiatrists are essential. Data on the efficacy of beta-blockers and the renin-angiotensin-aldosterone system inhibitors for secondary prophylaxis are contradictory; statins and antiplatelet agents are not indicated in isolated TS. Pathogenetic methods are considered promising: antioxidants (α-lipoic acid, tempol), natural compounds (icariin, pomegranate peel extract), as well as new classes of drugs (sodium-glucose cotransporter type 2 inhibitors, angiotensin receptor-neprilysin inhibitors). However, the clinical benefit of these drugs is not confirmed. Conclusion. The optimal strategy includes individualized drug therapy, active detection and correction of psycho-emotional disorders, as well as further research into pathogenetically oriented therapies for takotsubo syndrome.