Is it possible to differentiate between Takotsubo cardiomyopathy and acute anterior ST-elevation myocardial infarction?

Usefulness of ECG to differentiate Takotsubo cardiomyopathy from acute coronary syndrome

“…Although the T-wave criteria identified in this study appear to be promising discriminators between TC and MI the low incidence of TC relative to MI in those presenting to hospital with suspected ACS [27] means that the positive and negative predictive values of these criteria may be relatively poor when evaluated, as is required, in an all-comer suspected ACS population. We note that other proposed ECG markers from other studies have not been validated by subsequent reports [5,6,12,13,28]. Thirdly, we did not compare the ECG changes between apical and mid-ventricular variants of TC due to the small number of midventricular variants.…”

Electrocardiogram differentiating acute ST-segment elevation myocardial infarction from Takotsubo syndrome

“…In the spirit of the above, it would be contributory if the authors of the present report [1], could provide data (if available) on: (1) LVQRS in the triage ECG of their 140 patients; (2) RVQRS between the triage ECGs and subsequently recorded ECGs until, or even after, the time of performance of coronary arteriography; and (3) RVQRS between the triage ECG and available ECGs recorded prior to the patients' admission.…”

“…The article by Vervaat et al [1], published online ahead of print on February 20, 2015 in the Journal, about a potential role of the electrocardiogram (ECG) to convincingly differentiate Takotsubo syndrome (TTS) from an acute anterior ST-segment elevation myocardial infarction (AASTEMI), is contributory to our quest to explore for a method enabling physicians to conclude that they are dealing with TTS, where conservative management is in order, or AASTEMI, where expeditious percutaneous coronary interventions, or thrombolysis are indicated. The authors appropriately contrasted their 37 patients with TTS (34 female) with 103 female patients with AASTEMI [1], considering the immense propensity of women to suffer TTS.…”

“…The authors appropriately contrasted their 37 patients with TTS (34 female) with 103 female patients with AASTEMI [1], considering the immense propensity of women to suffer TTS. Indeed the female gender and the postmenopausal state are 2 variables to be focusing upon, while the triage (first) ECG is being analyzed, and thus a serious consideration should be given to the diagnosis of TTS.…”

“…Indeed the female gender and the postmenopausal state are 2 variables to be focusing upon, while the triage (first) ECG is being analyzed, and thus a serious consideration should be given to the diagnosis of TTS. The authors concluded that "the ECG criteria investigated", "were insufficient to reliably distinguish patients with TTS from patients with an AASTEMI", and thus "to definitely exclude the diagnosis of an AASTEMI coronary angiography", which "remains the gold standard", and "needs to be performed" [1].…”