Jen-Li Looi1, Chi-Wing Wong2, Mildred Lee2, Ali Khan3, Mark Webster4, Andrew J Kerr2. 1. Department of Cardiology, Middlemore Hospital, Private Bag 93311, Otahuhu, Auckland, New Zealand. Electronic address: JenLi.Looi@middlemore.co.nz. 2. Department of Cardiology, Middlemore Hospital, Private Bag 93311, Otahuhu, Auckland, New Zealand. 3. Cardiovascular Division, North Shore Hospital, 124 Shakespeare Road, Takapuna, Auckland 0622, New Zealand. 4. Green Lane Cardiovascular Service, Auckland City Hospital, 2 Park Road Grafton, Auckland 1023, New Zealand.
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.
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 MIpatients. 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 STEMIpatients 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 STEMIpatients had pathological Q-waves but none of the TC patients. Compared with NSTE-TC patients, NSTEMIpatients 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.
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