TAKOTSUBO SYNDROME: HIDDEN HEART RISKS IN INTENSIVE CARE UNITS

A little-known but dangerous heart condition is quietly taking hold in intensive care units (ICUs), with Australian researchers warning that critically ill patients could be slipping through the cracks of detection with the hidden risks.

Takotsubo cardiomyopathy, more commonly known as Takotsubo syndrome, has traditionally been described as Broken Heart syndrome because it is often triggered by extreme stress.

While once thought to be rare and confined mainly to those who had experienced sudden emotional trauma, clinicians are increasingly observing the disorder among ICU patients whose bodies are already under immense physical strain.

A SERIOUS, OFTEN MISSED CONDITION

The syndrome temporarily weakens the heart’s left ventricle, leading to symptoms almost indistinguishable from a heart attack — chest pain, shortness of breath, and changes in ECG readings.

Unlike a heart attack, though, Takotsubo syndrome does not usually involve blocked arteries. If left undiagnosed, the consequences can be dire: irregular heart rhythms, fluid in the lungs, heart failure, blood clots, cardiac arrest and, in some cases, sudden death.

Despite the seriousness of the condition, there are no clear ICU protocols to ensure early detection. This gap is what researchers at the University of South Australia (UniSA) are now aiming to close.

NEW RESEARCH OFFERS EARLY WARNING

In a systematic review of diagnostic practices, UniSA investigators identified 14 studies that used electrocardiogram (ECG) patterns, 11 that tested blood biomarkers, and five that relied on imaging to detect temporary heart dysfunction associated with Takotsubo syndrome.

According to the research, combining these tools into a structured ICU-specific pathway could allow nurses and doctors to flag the condition earlier and intervene before it escalates.

The findings highlight the crucial role of critical care nurses, particularly those with advanced ECG interpretation skills, in identifying subtle warning signs during routine assessments.

WHY ICU PATIENTS ARE AT RISK

Lead researcher and experienced critical care nurse Vicky Visvanathan from UniSA says ICU patients present unique challenges because their primary illnesses often mask the syndrome.

“Takotsubo syndrome is often seen in high-risk ICU patients with a variety of illnesses, surgeries, or after certain procedures and anaesthetic drugs,” Visvanathan says.

“But because these patients are so unwell, their symptoms can be masked by their primary illness, making the syndrome extremely difficult to detect.

“We know that reported cases of Takotsubo syndrome in ICUs vary widely from 1.5% to 28%, which we believe is due to inconsistent detection.

“By developing an ICU-specific clinical pathway that integrates existing diagnostic tools, we can help critical care nurses detect early changes in a patient’s condition, allowing them to identify Takotsubo syndrome and initiate appropriate treatment.

“Early recognition can be the difference between recovery and a potentially fatal complication. We have the tools – now we need to integrate them into ICU care.”

MOVING TOWARD CLINICAL CHANGE

The UniSA team has drafted a proposed Clinical Pathway explicitly designed for ICU settings. This framework, now under review by clinical teams, integrates ECG findings, biomarker testing and imaging into a unified system aimed at guiding frontline staff through detection, diagnosis and treatment decisions.

If implemented, the pathway could provide a much-needed safety net for patients at risk of Takotsubo syndrome, ensuring consistency across hospitals and potentially saving lives.

A BROADER HEALTH ISSUE

Takotsubo syndrome has been gaining recognition internationally, not only in critical care but also among cardiologists treating community patients. Its links to stress, both emotional and physical, highlight the intricate relationship between the brain and the heart, and how trauma can manifest in life-threatening ways.

For ICUs already dealing with overstretched resources, the condition adds another layer of complexity. With patient numbers rising and many presenting with multiple illnesses, the call to arm nurses and doctors with clearer tools has never been more urgent.

The UniSA research is part of a broader shift toward improving awareness of stress-induced heart conditions and ensuring that early intervention becomes standard practice. For patients, it could mean the difference between being discharged after treatment or facing catastrophic complications.