**1. Introduction**

Takotsubo syndrome (TTS) also known as left ventricular apical ballooning syndrome (LVBS), transient apical ballooning, broken heart syndrome or stress cardiomyopathy is an acute and reversible wall motion abnormality classically of the left ventricular myocardium, commonly but not exclusively seen among the Asian population. Takotsubo syndrome was first diagnosed in Hiroshima City Hospital Japan, in 1983 [1]. Sato and Dote in 1990 and 1991 introduced the term takotsubo (tako = octopus, tsubo = a pot) to describe the left ventricular silhouette during systole in five patients presenting with clinical features of myocardial infarction but without obstructive coronary artery disease [2].

(The syndrome is characterized by regional left ventricular wall motion abnormality (LVWMA) with a peculiar circumferential pattern resulting in a conspicuous ballooning of the left ventricle during systole as seen in **Figure 1a** and **b**. The LVWMA extends beyond a single coronary artery supply region and is reversible with almost complete resolution of ventricular dysfunction in hours to weeks depicted in **Figure 1c** and **d**). The LVWMA may be localized to the apical, midapical, midventricular, midbasal, or basal segments of the left ventricle [4].

However TTS gained international attention in the early 2000s, when the first diagnostic criteria: including apical dyskinesia/akinesia with basal hyperkinesia, absence of obstructive coronary artery disease (CAD) on coronary angiography, new electrocardiographic abnormalities, modest elevation in serum cardiac troponin in the absence of pheochromocytoma, and myocarditis, were published [5].

Recently, the Heart Failure Association of the European Society of Cardiology in a position statement from the task force on TTS introduced the terms primary and secondary TTS. They reported that "Acute cardiac symptoms are the primary reason for seeking medical care in primary TTS while in secondary TTS, the syndrome occurs in patients already hospitalized for a medical or surgical condition" [6].

#### **Figure 1.**

*Left ventriculography during the acute stage of takotsubo syndrome shows typical midapical ballooning during systole (a) diastole, (b) systole. Cardiac magnetic resonance imaging 4 days after left ventriculography shows complete normalization of the left ventricular function (c) diastole, (d) systole. The figure is reproduced with permission from Y-Hassan et al. [3].*

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**Figure 2.**

*by Minhas et al. [11].*

*Overview of the Global Prevalence and Diagnostic Criteria of Takotsubo Syndrome*

has also been reported in all age groups and even in children [6].

The prevalence of TTS has been reported to be approximately 2% of all patients presenting with clinical manifestation of ACS and up to 10% if only women are considered [7]. More than 85% of the patients with TS are said to be postmenopausal women (aged 65–70 years) thus suggesting a possible hormonal response [6]. In Western countries, there is a female-to-male ratio of 9:1 [8], in contrast, men are more affected than women, for unknown reasons in Japan [9]. The syndrome

Since the introduction of the term takotsubo in 1990 [4], TTS has increasingly gained more recognition in almost all countries of the world. The syndrome has been reported in a variety of races, the incidence and prevalence are rising in the Western countries due to greater awareness and widespread access to early invasive coronary angiography, but the syndrome is infrequently seen among African and Hispanics descents which maybe be due to poor awareness of the disease [10]. Minhas et al. reported from study done among North American population almost 20 times increase in the incidence of TTS from 2006 to 2012 (**Figure 2**) [11]. Similarly, a study by Murugiah et al. showed that hospitalization rates for TTS are increasing, in that study the incidence of primary TTS increased from 2.3 to 7.1 hospitalizations per 100,000 person-years in 2007 to 2012. The corresponding incidence for secondary TTS increased from 3.4 hospitalizations per 100,000 person-years in

The proposed mechanism for the pathogenesis and pathophysiology of TS are complex and multifactorial which include acute reversible myocardial ischemia resulting from multivessel coronary artery spasm, microvascular dysfunction, left ventricular outflow tract obstruction (LVOTO), blood-borne catecholamine induced myocardial toxicity, epinephrine-induced switch in the intracellular signal

*Trends in reported incidence of takotsubo syndrome from 2006 to 2012. Modified with permission from a table* 

*DOI: http://dx.doi.org/10.5772/intechopen.93319*

**2. Global prevalence**

2007 to 10.3 in 2012 [12].

**2.1 Pathogenesis/pathophysiology**

*Overview of the Global Prevalence and Diagnostic Criteria of Takotsubo Syndrome DOI: http://dx.doi.org/10.5772/intechopen.93319*
