Takotsubo cardiomyopathy (TCM), also known as stress cardiomyopathy or "broken heart syndrome," is a transient form of acute heart failure that mimics acute coronary syndrome (ACS) but typically occurs without obstructive coronary artery disease. Though once considered rare, TCM is increasingly recognized in clinical practice, particularly among postmenopausal women. Despite its rising incidence, significant knowledge gaps remain in its pathophysiology, diagnosis, management, and long-term outcomes. A contemporary understanding of TCM is critical for clinicians to accurately differentiate it from other acute cardiac conditions and provide patient-centered care. This narrative review synthesizes the current literature on TCM, with a focus on evolving theories of pathophysiology, including catecholamine surge and neurocardiac axis dysfunction, alongside emerging diagnostic strategies which may implicate microvascular involvement. We examine the expanding role of cardiac imaging modalities and biomarker profiles in differentiating TCM from ACS, as well as current best practices in acute and long-term management.