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Usefulness of ECG to differentiate Takotsubo cardiomyopathy from acute coronary syndrome.
Int J Cardiol. 2015 Jul 14;199:132-140
Authors: Looi JL, Wong CW, Lee M, Khan A, Webster M, Kerr AJ
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 2mm vs. 3mm, 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.
PMID: 26188834 [PubMed - as supplied by publisher]