**Author details**

prophylactic anticoagulation with unfractionated or low-molecular weight heparin is also debatable, but experts have suggested that TTS patients with extensive segmental akinesia

Takotsubo syndrome has been associated with a growing list of complications of varied severity, contributing to its mortality rate. Almost 52% of all patients have been reported to develop some form of complication in course of this disease [62, 63]. These include acute heart failure, left ventricular outflow tract obstruction, cardiogenic shock, arrhythmias, thrombus forma-

Acute heart failure develops in almost 12–45% of all patients with TTS and, in some patients, it is exacerbated by mitral regurgitation and/or left ventricular tract obstruction. Patients could have significantly elevated LVOT gradients (20–140 mmHg), and those with values greater than 40 mmHg are predisposed to develop hypotension and cardiogenic shock. It has been demonstrated that the use of inotropic drugs exacerbates this LVOT obstruction, while beta-blockers decrease it. Around 4–20% of all TTS patients show symptoms of cardiogenic shock, while almost 9% of them document ventricular arrhythmias during the acute phase. Thrombi develop generally 2–5 days after the index event and are known to resolve after 2 weeks of therapeutic anticoagulation (treatment regimen of at least 3 months). There are also instances of patients presenting with a biventricular involvement, which has been associated

The Takotsubo syndrome is essentially a benign disease and the prognosis is favourable in most patients. The regional wall-motion abnormalities usually resolve spontaneously within a few days to weeks; however, there have been instances where TTS has persisted due to complications associated with apical thrombus formation [64, 65]. Recent studies have demonstrated that the in-hospital death rate ranges between 0 and 8%, while recurrence rates

These results have eschewed renewed interest into the study of Takotsubo syndrome and mechanisms contributing to its pathophysiology. Patients are now recommended routine follow-ups after 3–6 months to evaluate the progress of disease and help better understand its

Limited current knowledge and often contradictory data have fuelled the debate surrounding the Takotsubo syndrome. There is an urgent need for multiple randomised controlled trials and large registries to optimise existing clinical goals and management strategies, and the

tion, pericardial effusion, right ventricular involvement and ventricular wall rupture.

could be started on a regimen with therapeutic doses of LMWH.

with a poorer prognosis and a higher frequency of heart failure [10].

**12. Prognosis and conclusion**

evolutionary dynamics.

fluctuate anywhere between 0 and 15% [66, 67].

launch of InterTAK registry is a step forward in this regard.

**11. Complications**

226 Interventional Cardiology

Uzair Ansari\* and Ibrahim El-Battrawy

\*Address all correspondence to: uzair.ansari@yahoo.com

First Department of Medicine, Medical Faculty Mannheim, University Heidelberg, Mannheim, Germany
