What are the diagnostic challenges of Takotsubo Syndrome?

The Bottom Line: The most common presenting symptoms are chest pain (68%) and breathlessness (17%), but approximately 4% of patients present with cardiogenic shock and 1.5% with ventricular fibrillation.  See chart, “Proposed Mayo Clinic criteria for the clinical diagnosis of TC.”

Reference: Zeb M, Sambu N, Scott P, Curzen N.  Takotsubo cardiomyopathy: a diagnostic challenge. Postgrad Med J. 2011 Jan;87(1023):51-9.   

 

Summary: The frequency of the diagnosis of takotsubo cardiomyopathy has increased rapidly over the past few years, possibly due to increasing awareness among cardiologists. At initial presentation the diagnosis remains a challenge because of the close similarity between the presentation of takotsubo cardiomyopathy, and that of ST elevation myocardial infarction (STEMI). Recognition of salient aspects of the medical history at presentation are important in order to organise further appropriate investigations such as echocardiography and left ventriculography at the time of coronary angiogram. Takotsubo cardiomyopathy can be easily missed without ventriculography early after presentation because of the transient nature of left ventricular dysfunction, and in many centres left ventriculogram is not done as standard in the setting of STEMI. The authors advocate left ventriculography in all cases of ST elevation who have unobstructed coronaries. The correct diagnosis of takotsubo cardiomyopathy is very important for future advice and management of the patient.

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