Diagnostic challenges between takotsubo cardiomyopathy and acute myocardial infarction—where is the emergency?: a literature review

Abstract

Background Takotsubo cardiomyopathy (TC) is an emergency cardiovascular disease, with clinical and paraclinical manifestations similar to acute myocardial infarction (AMI), but it is characterized by reversible systolic dysfunction of the left ventricle (LV) in the absence (most of the time) of obstructive coronary artery disease (CAD). Management of patients with TC TC seems to be more frequent in post-menopausal women and it is triggered by emotional or physical stress. The diagnosis of TC is based on the Mayo Clinic criteria. Initially, patients with TC should be treated as those with AMI and carefully monitored in intensive care unit. Urgent clinical and paraclinical distinction between TC and AMI is mandatory in all patients, because of the different therapeutical management between the two diseases. Chest pain and dyspnea are the most common symptoms in TC. Paraclinical diagnosis is based on cardiac biomarkers, electrocardiogram (ST-segment elevation/T wave inversion in precordial leads without reciprocal ST-segment depression in inferior leads and absence of Q waves), echocardiography (LV systolic dysfunction, regional wall motion abnormalities extended in more than one coronary territory), cardiac magnetic resonance and in most of the cases the positive diagnosis is established by performing CA to exclude obstructive CAD. The prognosis of patients with TC is considered benign in most cases, with a complete LV function recovery, but severe complications may occur, such as cardiogenic shock, LV free wall rupture, life-threatening arrhythmia, and cardiac arrest. Postoperative TC may develop after any type of surgical intervention due to acute stress and it should be differentiated from postoperative AMI. The management of patients with TC is medical and it is based on supportive care and the treatment of heart failure, while patients with AMI require myocardial revascularization. Conclusions TC leads to transient LV dysfunction that mimics AMI from which it should be differentiated for a good therapeutic approach. Patients with TC should be carefully monitored during hospitalization because they have a high recovery potential if optimally treated.

Ventricular apical wall rupture and ventricular aneurysm formation concurrent with ventricular septal dissection and rupture due to ST-segment elevation myocardial infarction: a case report

“…Stress cardiomyopathy, which is also called Takotsubo cardiomyopathy (TC), is reported in about 2–3% of all troponin-positive suspected acute coronary syndrome (ACS) cases [ 10 ]. TC is similar to ACS and is characterized by reversible left ventricular apical ballooning in the absence of angiographically substantial coronary artery stenosis.…”

Takotsubo syndrome after concomitant surgical ablation for the treatment of atrial fibrillation in patients undergoing minimally invasive mitral valve surgery: A clinical case and review

“…Utilizing the InterTAK Diagnostic Score scale to differentiate between TTS and acute coronary syndrome (ACS) in the acute stage, this female patient, who underwent cardiac surgical intervention, exhibited a prolonged QTc and no presence of ST depression, resulting in a score of 55 points. With a score of ≥50 points, the probability of a positive TTS diagnosis in this patient rises to 95 % [ 7 , 8 ]. According to the TTS diagnostic flow chart outlined by the European Society of Cardiology (ESC), the patient underwent a coronary angiogram.…”