Indications of beta-adrenoceptor blockers in Takotsubo syndrome and theoretical reasons to prefer agents with vasodilating activity

Takotsubo syndrome (TTS) is estimated to account for 1-3% of all patients presenting with suspected ST-segment elevation myocardial infarction. A sudden surge in sympathetic nervous system is considered the cause of TTS. Nonetheless, no specific recommendations have been provided regarding beta-blocking therapy. Apart from specific contra-indications (severe LV dysfunction, hypotension, bradycardia and corrected QT interval >500 ms), treatment with a beta-blocker seems reasonable until full recovery of LV ejection fraction, though evidence is limited to a few animal studies, case reports or observational studies. In this review, we will reappraise the rationale for beta-blocker therapy in TTS and speculate on the pathophysiologic basis for preferring non-selective agents with vasodilating activity over beta(1)-selective drugs. (C) 2021 Elsevier B.V. All rights reserved.

Automated summary

Takotsubo syndrome (TTS) accounts for 1-3% of patients with suspected ST-segment elevation myocardial infarction, with a sudden surge in sympathetic nervous system considered as the cause. While no specific recommendations exist, beta-blocker therapy may be reasonable for TTS treatment until LV ejection fraction fully recovers, despite limited evidence.