Usefulness of ECG to differentiate Takotsubo cardiomyopathy from acute coronary syndrome. (15th November 2015) - Looi, Jen-Li
Abstract: Objective: We aimed to describe the evolution of ECG changes in TC compared with MI, and evaluate ECG features which might help to distinguish between these conditions. Background: Takotsubo cardiomyopathy (TC) can mimic both ST-elevation (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) but management is different. Several electrocardiographic (ECG) abnormalities have been identified which might help to differentiate TC with and without ST-elevation, from STEMI and NSTEMI, respectively. Methods: We prospectively identified 100 consecutive patients with TC and 100 MI patients. They were divided into 2 groups according to the presence of ST-segment elevation (STE). Serial ECGs from admission to Day 2 were compared. Results: Thirty-five TC patients had STE on admission. Compared with STEMI patients they had less prominent STE (median peak elevation 2 mm vs. 3 mm, P < 0.05), less reciprocal ST-segment depression and no abnormal Q-waves. By Day 2 all STEMI patients had pathological Q-waves but none of the TC patients. Compared with NSTE-TC patients, NSTEMI patients had more ST-segment depression (28.2% vs. 0%, P < 0.05), but less T-wave inversion (33.8% vs. 11.3%, P < 0.05) on admission. By Day 2 the ECG criterion which best distinguished NSTE-TC from NSTEMI was the presence of T-wave inversion in ≥ 6 leads (sensitivity 74%, specificity 92%). Conclusion: ECG changes seen in TC within two days of presentation are distinctive and important clues for clinicians to suspect the diagnosis.