Differential diagnosis of takotsubo syndrome and acute myocardial infarction according to electrocardiographic studies (literature review and own results)
AbstractTakotsubo syndrome (TS), which is increasingly being detected due to modern diagnostic methods, is a myocardial disease that has to be differentiated, first of all, from acute myocardial infarction. The review presents current literature data on electrocardiographic features in TS, which help to timely differentiate this pathological condition from myocardial infarction. We also present our own analysis of the electrocardiography’s results in patients with TS.
Keywords:takotsubo syndrome; myocardial infarction; electrocardiogram; differential diagnosis
Funding. The study was financially supported by a grant from Prof. E.E. Eichwald North-Western State Medical University named after I.I. Mechnikov, Ministry of Health of the Russian Federation.
Conflict of interest. The authors declare no conflict of interest.
Authours’ contribution. The authors declare the compliance of their authorship according to the international ICMJE criteria. All authors made a substantial contribution to the conception of the work, acquisition, analysis, interpretation of data for the work, drafting and revising the work, final approval of the version to be published and agree to be accountable for all aspects of the work.
For citation: Evdokimov D.S., Boldueva S.A., Syromyatnikova A.V. Differential diagnosis of takotsubo syndrome and acute myocardial infarction according to electrocardiographic studies (literature review and own results). Kardiologiya: novosti, mneniya, obuchenie [Cardiology: News, Opinions, Training]. 2023; 11 (2): 30–9. DOI: https://doi.org/10.33029/2309-1908-2023-11-2-30-39 (in Russian)
References
1. Ghadri J.R., Wittstein I.S., Prasad A., et al. International expert consensus document on takotsubo syndrome (part I): clinical characteristics, diagnostic criteria, and pathophysiology. Eur Heart J. 2018; 39 (22): 2032–46.
2. Amin H.Z., Amin L.Z., Pradipta A. Takotsubo cardiomyopathy: a brief review. J Med Life. 2020; 13 (1): 3–7.
3. Templin C., Ghadri J.R., Diekmann J., et al. Clinical features and outcomes of takotsubo (stress) cardiomyopathy. N Engl J Med. 2015; 373: 929–38.
4. Ghadri J.R., Ruschitzka F., Lüscher T.F., Templin C. Takotsubo cardiomyopathy: still much more to learn. Heart. 2014; 100 (22): 1804–12.
5. Frangieh A.H., Obeid S., Ghadri J.R., et al. ECG criteria to differentiate between takotsubo (stress) cardiomyopathy and myocardial infarction. J Am Heart Assoc. 2016; 5 (6): e003418.
6. Ghadri J.R., Wittstein I.S., Prasad A., et al. International expert consensus document on takotsubo syndrome (part II): diagnostic workup, outcome, and management. Eur Heart J. 2018. Vol. 39, N 22. P. 2047–62.
7. Ghadri J.R., Cammann V.L., Jurisic S., et al. A novel clinical score (InterTAK Diagnostic Score) to differentiate takotsubo syndrome from acute coronary syndrome: results from the International Takotsubo Registry. Eur J Heart Fail. 2017; 19 (8): 1036–42.
8. Núñez G., Andrés M., Almendro Delia M., et al. Characterization of tako-tsubo cardiomyopathy in Spain: results from the RETAKO National Registry. Rev Esp Cardiol (Engl Ed). 2015; 68 (6): 505–12.
9. Rawish E., Stiermaier T., Santoro F., et al. Current knowledge and future challenges in takotsubo syndrome: part 1 – pathophysiology and diagnosis. J Clin Med. 2021; 10 (3): 479.
10. Santoro F., Brunetti N.D., Tarantino N., et al. Dynamic changes of QTc interval and prognostic significance in takotsubo (stress) cardiomyopathy. Clin Cardiol. 2017; 40: 1116–22.
11. Namgung J. Electrocardiographic findings in takotsubo cardiomyopathy: ECG evolution and its difference from the ECG of acute coronary syndrome. Clin Med Insights Cardiol. 2014; 8: 29–34.
12. Kurisu S., Inoue I., Kawagoe T., et al. Time course of electrocardiographic changes in patients with tako-tsubo syndrome: comparison with acute myocardial infarction with minimal enzymatic release. Circ J. 2004; 68: 77–81.
13. Ogura R., Hiasa Y., Takahashi T., et al. Specific findings of the standard 12-lead ECG in patients with «takotsubo» cardiomyopathy: comparison with the findings of acute anterior myocardial infarction. Circ J. 2003; 67 (8): 687–90.
14. Koulouris S., Pastromas S., Sakellariou D., Kratimenos T., Piperopoulos P., Manolis A.S. Takotsubo cardiomyopathy: the «broken heart» syndrome. Hellenic J Cardiol. 2010; 51 (5): 451–7.
15. Tarantino N., Santoro F., Guastafierro F., et al. «Lambda-wave» ST-elevation is associated with severe prognosis in stress (takotsubo) cardiomyopathy. Ann Noninvasive Electrocardiol. 2018; 23 (6): e12581.
16. Tsuchihashi K., Ueshima K., Uchida T., et al. Transient left ventricular apical ballooning without coronary artery stenosis: a novel heart syndrome mimicking acute myocardial infarction. Angina Pectoris-Myocardial Infarction Investigations in Japan. J Am Coll Cardiol. 2001; 38 (1): 11–8.
17. Guerra F., Rrapaj E., Pongetti G., et al. Differences and similarities of repolarization patterns during hospitalization for takotsubo cardiomyopathy and acute coronary syndrome. Am J Cardiol. 2013; 112 (11): 1720–4.
18. Duran-Cambra A., Sutil-Vega M., Fiol M., et al. Systematic review of the electrocardiographic changes in the takotsubo syndrome. Ann Noninvasive Electrocardiol. 2015; 20 (1): 1–6.
19. Santoro F., Stiermaier T., Tarantino N., et al. Impact of persistent ST elevation on outcome in patients with takotsubo syndrome. Results from the GErman Italian STress Cardiomyopathy (GEIST) registry. Int J Cardiol. 2018; 255: 140–4.
20. Thakar S., Chandra P., Hollander G., Lichstein E. Electrocardiographic changes in takotsubo cardiomyopathy. Pacing Clin Electrophysiol. 2011; 34 (10): 1278–82.
21. Madias J.E. Electrocardiogram features and course in patients with takotsubo syndrome. Int J Cardiol. 2021; 324: 22.
22. Kosuge M., Ebina T., Hibi K., et al. Differences in negative T waves between takotsubo cardiomyopathy and reperfused anterior acute myocardial infarction. Circ J. 2012; 76 (2): 462–8.
23. Sclarovsky S., Nikus K. The electrocardiographic paradox of tako-tsubo cardiomyopathy – comparison with acute ischemic syndromes and consideration of molecular biology and electrophysiology to understand the electrical-mechanical mismatching. J Electrocardiol. 2010; 43 (2): 173–6.
24. Sharkey S.W. Electrocardiogram mimics of acute ST-segment elevation myocardial infarction: insights from cardiac magnetic resonance imaging in patients with tako-tsubo (stress) cardiomyopathy. J Electrocardiol. 2008; 41 (6): 621–5.
25. Madias J.E., Bazaz R., Agarwal H., Win M., Medepalli L. Anasarca-mediated attenuation of the amplitude of electrocardiogram complexes: a description of a heretofore unrecognized phenomenon. J Am Coll Cardiol. 2001; 38 (3): 756–64.
26. Zorzi A., Migliore F., Perazzolo Marra M., Tarantini G., Iliceto S., Corrado D. Electrocardiographic J waves as a hyperacute sign of takotsubo syndrome. J Electrocardiol. 2012; 45 (4): 353–6.
27. Awad H.H., McNeal A.R., Goyal H. Reverse takotsubo cardiomyopathy: a comprehensive review. Ann Transl Med. 2018; 6 (23): 460.
28. Jim M.H., Chan A.O., Tsui P.T., et al. A new ECG criterion to identify takotsubo cardiomyopathy from anterior myocardial infarction: role of inferior leads. Heart Vessels. 2009; 24: 124–30.
29. Kosuge M., Ebina T., Hibi K., et al. Simple and accurate electrocardiographic criteria to differentiate takotsubo cardiomyopathy from anterior acute myocardial infarction. J Am Coll Cardiol. 2010; 55 (22): 2514–6.
30. Parkkonen O., Allonen J., Vaara S., Viitasalo M., Nieminen M.S., Sinisalo J. Differences in ST-elevation and T-wave amplitudes do not reliably differentiate takotsubo cardiomyopathy from acute anterior myocardial infarction. J Electrocardiol. 2014; 47 (5): 692–9.
31. Çatalkaya Demir S., Demir E., Çatalkaya S. Electrocardiographic and seasonal patterns allow accurate differentiation of tako-tsubo cardiomyopathy from acute anterior myocardial infarction: results of a multicenter study and systematic overview of available studies. Biomolecules. 2019; 9 (2): 51.
32. Kosuge M., Ebina T., Hibi K., et al. Differences in negative T waves among acute coronary syndrome, acute pulmonary embolism, and takotsubo cardiomyopathy. Eur Heart J Acute Cardiovasc Care. 2012; 1 (4): 349–57.
33. Laurence G., Vasiliu A., Blommaert D., et al. Typical dynamic electrocardiographic changes in takotsubo syndrome. Acta Cardiol. 2022; 77 (2): 146–52.
34. Mir T., Prakash P., Sattar Y., et al. Takotsubo syndrome vs anterior STEMI electrocardiography; a meta-analysis and systematic review. Expert Rev Cardiovasc Ther. 2020; 18 (11): 819–25.
35. Mugnai G., Pasqualin G., Benfari G., et al. Acute electrocardiographic differences between takotsubo cardiomyopathy and anterior ST elevation myocardial infarction. J Electrocardiol. 2015; 48 (1): 79–85.
36. Zorzi A., Baritussio A., ElMaghawry M., Siciliano M., Migliore F., Perazzolo Marra M., et al. Differential diagnosis at admission between takotsubo cardiomyopathy and acute apical-anterior myocardial infarction in postmenopausal women. Eur Heart J Acute Cardiovasc Care. 2016; 5 (4): 298–307.
37. Golovina G.A., Zafiraki V.K., Kosmacheva E.V. Drug-induced long QT syndrome. Vestnik aritmologii [Bulletin of Arrhythmology]. 2020; 27 (3): 42–52. (in Russian)