<p>Takotsubo syndrome (TTS), otherwise known as stress cardiomyopathy or broken heart syndrome, is a reversible transient state of acute cardiac dysfunction. There is a systolic impairment in the left ventricle in absence of any obstruction of the coronary artery. A significant association between stress, psychological disorders and TTS suggests a key role of the brain-heart axis in cardiovascular physiology.</p>

<p>Autonomic dysfunction, catecholamine overload, activation of the hypothalamic-pituitary-adrenal axis, inflammation and endothelial dysfunction are likely mechanisms involved in the genesis of TTS. It has been confirmed that depression, panic attacks, anxiety, psychological trauma and chronic stressful lifestyle are correlated with a higher predisposition towards sympathetic overdrive and myocyte damage. Recent advances in psychocardiology and neurocardiology have explained the neurocardiac mechanisms behind stress-induced cardiomyopathy. This narrative review addresses the epidemiology, psychiatric comorbidities, pathogenesis and clinical presentation of TTS, as well as the methods of diagnosis, treatment and future perspective, focusing on the role of psychiatric triggers and neurocardiac pathways.</p>