 The presenting ECG in Takotsubo is subtly different than the presenting ECG of myocardial infarction, by fewer total abnormal leads, lesser total magnitude of STelevation and lesser pathological Q waves. The 4-day evolution of the Takotsubo ECG compared to acute myocardial infarction is characterised by much more widespread and deeper T wave inversion. The mean QTc progressively increases in takotsubo whilst in MI decreases.

 The presenting ECG in Takotsubo is subtly different than the presenting ECG of myocardial infarction, by fewer total abnormal leads, lesser total magnitude of STelevation and lesser pathological Q waves. The 4-day evolution of the Takotsubo ECG compared to acute myocardial infarction is characterised by much more widespread and deeper T wave inversion. The mean QTc progressively increases in takotsubo whilst in MI decreases.

Introduction: Tako-tsubo cardiomyopathy (TTC) is an acute form of left ventricular systolic impairment that mimics acute myocardial infarction (MI) in its presentation. Here we explore if any differences in ECG morphology/time-course may add confidence in separating the two conditions. Methods: We examined serial ECG's of 21 consecutive acute TTC patients (66±9 years, 19 F) & 21 MI patients (58±9 years, 6F), all with anterior ST elevation. We analysed the following parameters from day 0 to day 3: Number of abnormal leads, Magnitude of ST elevation in each lead and sum of the ST elevation in all leads, T wave amplitude in each lead and sum of the T wave amplitude in all leads, mean 12-lead QT and QTc intervals. Results: All ECG's were in sinus rhythm. The presenting ECG (day 0) showed: 1) significantly fewer abnormal leads in the TTC vs MI group (7±0.5 vs 8.6±0.5, p=0.04) but similar number of leads with ST elevation; 2) significantly lower mean magnitude of ST elevation in the TTC vs MI group (0.91±0.19 mm vs 1.71±0.19mm, p<0.006); and 3) significantly lower sum of T wave amplitude in the TTC vs MI group (16.4±13 vs 25.7±14 p=0.028) -this remained significant on day 1 (0.29±15 mm vs 18.8±8 mm, p<0.001 and day 2 (-11.82±12.4mm vs 9.3±12.4mm, p=0.018) and showed a similar trend in day 3 (-28.18±29.0 mm vs 6.5±16.1 mm, p=0.06) -See Figure The was no significant difference in the QTc between the 2 groups on the day of presentation however on day 1 the QTc was significantly longer in the TTC group (457.7±10.3ms vs 416±10.7ms, p=0.006). The change in QTc between Day 0 and day 3 was significantly greater in the TTC group when compared to the MI group (48.02±9.75 vs 28.5±11.2, p=0.000).T wave amplitude in TTC vs MI day 0-3 Conclusion:The differences in presenting (day 0) ECG between TTC and MI are significant but subtle. We describe further differences in the post-acute phase with significantly greater T wave amplitude changes in TTC compared with MI developing in days 1-3 and a QTc interval that increases significantly in TTC vs MI between days 0-3. These findings firstly aid in the diagnostic confidence of those patients with non-obstructive coronary arteries and secondly, may provide further insight into the distinctive pathophysiology of the two conditions.