ECG differences and ECG predictors in patients presenting with ST segment elevation due to myocardial infarction versus takotsubo syndrome

Temporal electrocardiographic changes in anterior ST elevation myocardial infarction versus the Takotsubo syndrome

“…Other research has suggested a continuous spectrum between TTS and Prinzmetal angina, in which typical apical form TTS is suggested to arise from narrowing of all the mid- and distal branches of LAD [42] . Interestingly, we have previously demonstrated that ECG in TTS was particularly similar to STEMI with occlusion in LAD or any of its branches [4] .…”

“…A major strength of the present study compared to previous studies [4] , [9] , [11] , [12] , [13] , [14] , [16] is the prospective study design. This allowed us to obtain admission ECGs with similar time from symptom onset for all patients, as well as temporal ECGs at specific time-points that were similar across all three groups.…”

“…Several electrocardiographic (ECG) criteria has been proposed to distinguish between acute myocardial infarction (AMI) and TTS, none of which can reliably differentiate the two conditions to avoid coronary angiography to exclude coronary occlusion. [1] , [2] , [3] , [4] , [5] .…”

Takotsubo cardiomyopathy in India and its electrocardiography (ECG) comparison to myocardial infarction

“…In another study involving 15 TCM cases in Japan, the signs of T wave inversion with QT interval prolongation are evident [ 36 ]. Distinct patterns were identified in the ECG characteristics when we matched 40 cases of TCM with 39 cases of MI in our study: (1) There is equal frequency of ST segment elevation and T wave inversion in TCM cases with T wave inversion evident in a greater number of leads [ 37 ], (2) QTc was prolonged in only 37.5% of TCM cases unlike numerous studies which supported the prolonged QTc to be a more sensitive parameter [ 35 – 37 ], (3) Normal Q waves are present in TCM (25%), whereas MI cases have more frequent abnormal Q waves [ 35 ], (4) Reciprocal limb lead ST elevation is present in MI cases more frequently than TCM but they are not absolute in character, (5) ST segment depression is more prevalent in TCM cases than MI cases which deviates from earlier studies [ 38 ], (6) T wave inversion in TCM is a more significant with diffuse pattern lead involvement [ 39 ], (7) Poor R wave progression is seen in 20% of TCM cases compared to 15% of MI cases showing that TCM can have more evidence of poor R wave progression than MI [ 40 ] and (8) Complete heart blocks (CHB) are more evident in TCM [ 41 ] compared to bundle branch blocks ( BBB) [ 42 ], with none of the cases in our study showing BBB. All these conclusions prove that ECG characteristics may vary in different cases of TCM and MI and they do not form a sacrosanct criterion to come to a diagnosis on a sole basis.…”

Recent highlights on acute myocardial infarction and takotsubo syndrome from the International Journal of Cardiology: Heart & Vasculature

“…TTS presenting with ST elevation (STE-TTS) is especially challenging in the differential diagnosis against STEMI, and none of the proposed methods can clearly distinguish TTS from STEMI to reliably prevent coronary angiography. Zeijlon et al reported a comparative analysis between electrocardiographic characteristics of STE-TTS and STEMI patients and demonstrated that admission ECG in STE-TTS was similar to left anterior descending artery STEMI, but reciprocal ST depression was less common in STE-TTS compared with STEMI overall [35] .…”