Diagnostic Challenges in Takotsubo Syndrome: Bridging Mimics, Mechanisms, and Management

Takotsubo syndrome (TTS), also known as stress-induced cardiomyopathy, is a form of transient left ventricular systolic dysfunction that typically mimics acute coronary syndrome (ACS). Although increasingly recognized, its diagnosis remains challenging due to heterogeneous clinical presentations, evolving pathophysiological concepts, and significant overlap with other acute cardiac conditions. Contemporary criteria, including the InterTAK diagnostic framework, aim to refine case identification, yet distinctions from myocardial infarction, myocarditis, and other cardiomyopathies often remain blurred. Advances in multimodal imaging, biomarkers, and artificial intelligence hold promise for improving diagnostic precision. This review explores current diagnostic challenges in TTS, integrating clinical presentation, mechanistic understanding, and management implications. By bridging mimics, mechanisms, and management, we highlight the need for a nuanced, multidisciplinary approach that balances clinical vigilance with emerging diagnostic tools to optimize patients’ outcomes.