It’s often mistaken for a heart attack, but Takotsubo cardiomyopathy—previously known as Broken Heart syndrome—is a serious and sometimes fatal heart condition increasingly reported in intensive care units (ICUs). Yet without a clear clinical pathway in ICUs, it’s often missed, putting critically ill patients at risk.

New research from the University of South Australia shows that using electrocardiogram (ECG) patterns and blood markers could provide an early warning system for Takotsubo Syndrome in ICU patients.

The work is published in the journal Australian Critical Care.

The review highlights how critical care nurses with advanced ECG skills can play a key role in recognizing early signs of the condition during routine checks and alerting the medical team. It also underscores the need to establish Takotsubo syndrome-specific protocols to guide timely intervention in ICU settings.

Takotsubo syndrome is an acute cardiac disorder that’s usually triggered by severe emotional or physical stress. It causes temporary changes in how the heart’s left ventricle pumps, mimicking the symptoms of a heart attack. If untreated, it can lead to life-threatening complications, including irregular heartbeats, fluid build-up in the lungs, heart failure, blood clots, cardiac arrest, and in some cases, sudden death.

Assessing current diagnostic tools used to distinguish Takotsubo syndrome from other cardiac conditions, the study found 14 that used ECG patterns, 11 that used blood biomarkers, and five studies that used heart imaging to detect temporary changes in heart function linked to the syndrome.

Lead researcher, and experienced critical care nurse, UniSA’s Vicky Visvanathan, says there is a need to improve ICU clinical pathways for patients with possible Takotsubo syndrome.

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

The research team has developed a proposed Clinical Pathway for Takotsubo syndrome in the ICU, which is currently under review by clinical teams before implementation.