A New Electrocardiographic Criterion to Differentiate Between Takotsubo Cardiomyopathy and Anterior Wall ST-Segment Elevation Acute Myocardial Infarction

Tamura, Akira; Watanabe, Tôru; Ishihara, Masaharu; Ando, Shin-ichi; Naono, Shigeru; Zaizen, Hirofumi; Abe, Yoshiteru; Yano, Shoji; Shinozaki, Kazuo; Kotoku, Munenori; Momii, Hidetoshi; Kadokami, Toshiaki; Kadota, Jun‐ichi

doi:10.1016/j.amjcard.2011.04.006

Cited by 33 publications

(36 citation statements)

References 15 publications

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“…This STsegment deviation pattern observed both in TTC and AP is highly consistent with the ECG characteristics described in the literature. [6][7][8]13,14 In our cases, the common ST-segment deviation pattern in the limb leads, using the anatomically contiguous Cabrera sequence, was STE in aVL, I, − aVR, II and aVF, or in I, − aVR, II, aVF and III, indicating an ST vector pointing to around + 30°. 15 Therefore, all the patients showed STE in lead -aVR (+ 30°).…”

Section: Discussionmentioning

confidence: 57%

“…7,8 Classical TTC is characterized by transient wall motion abnormality, typically involving the apical and middle portions of the left ventricle, with hyperkinesia of the basal segments in the absence of significant coronary artery disease. 9,10 The ECG changes in TTC have been compared with the changes of different stages of acute myocardial infarction.…”

Section: Introductionmentioning

confidence: 99%

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ST-segment deviation pattern of takotsubo cardiomyopathy similar to acute pericarditis: Diffuse ST-segment elevation

Zhong-qun¹,

Chong-quan²,

Sclarovsky³

et al. 2013

Journal of Electrocardiology

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Section: Discussionmentioning

confidence: 57%

Section: Introductionmentioning

confidence: 99%

ST-segment deviation pattern of takotsubo cardiomyopathy similar to acute pericarditis: Diffuse ST-segment elevation

Zhong-qun¹,

Chong-quan²,

Sclarovsky³

et al. 2013

Journal of Electrocardiology

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“…Tamaru et al investigated the electrocardiographic criterion for differentiating TC from anterior AMI with ST-segment elevation. 12 They compared the magnitude of the ST-segment elevation at the J point between 62 patients with TC and 280 with anterior AMI. Patients with anterior AMI and ST-segment elevation were divided into 3 subgroups based on the site of culprit lesion of the left anterior descending coronary artery: 140 with the lesion proximal to the first diagonal branch, 120 with the lesion between the first and second diagonal branches, and 20 with the lesion distal to the second diagonal branch.…”

Section: Article P 462mentioning

confidence: 99%

“…Kosuge et al and Tamaru et al unanimously showed that, in the acute phase, ST-segment elevation in patients with TC is significantly less frequent in lead V1 and more frequent in leads aVL, -aVR, II and aVF, as compared with anterior AMI. 11, 12 Deep symmetrical T-wave inversions develop in TC patients within 24 to 48 h of symptom onset (subacute phase). It has been reported that the development of T-wave inversion in patients with TC mimics that in some patients with anterior AMI.…”

Section: Article P 462mentioning

confidence: 99%

Can Acute Myocardial Infarction Sneak Out From Takotsubo?

Hirai

2012

Circ J

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“…In fact, the most frequent ECG abnormalities described are STE, T-wave inversion and QT interval prolongation. [5][6][7][8] Recently, physicians and researchers have directed their attention to the time course of ECG changes in TTC. Obviously, the aim of these studies was not to confirm or exclude TTC with ECG, but to better understand the pathophysiologic process and compare the LV dysfunction with that observed in acute myocardial infarction (AMI).…”

mentioning

confidence: 99%

Takotsubo cardiomyopathy: which role for serial electrocardiogram changes?

Roncon¹,

Zuin²

2016

ICFJ

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Takotsubo cardiomyopathy (TTC) is a recently recognized cardiac syndrome characterized by acute, regional-reversible systolic dysfunction of the left ventricle (LV) and related to psycho-physical acute stress. 1 Generally, female gender is more involved, with the highest incidence between the seventh and eighth decade of life. 2 TTC could be easily confused with acute coronary syndrome (ACS); indeed, chest pain, dyspnoea and electrocardiographic changes, as ST-segment elevation (STE) or T-wave inversion, are common aspects to both diseases. 1,3,4 For these reasons, especially in the acute phase, differential diagnosis is essential for selecting the most appropriate treatment strategy. In several studies, the ECG presentation have been studied only in the early stage of TTC. In fact, the most frequent ECG abnormalities described are STE, T-wave inversion and QT interval prolongation. [5][6][7][8] Recently, physicians and researchers have directed their attention to the time course of ECG changes in TTC. Obviously, the aim of these studies was not to confirm or exclude TTC with ECG, but to better understand the pathophysiologic process and compare the LV dysfunction with that observed in acute myocardial infarction (AMI). Currently, TTC diagnosis is based on different clinical criteria, which take into account also ECG abnormalities.9-11 The lack of knowledge about the time course of the ECG changes in part is due to the low incidence of the disease. However, Kurisu et coll.12 demonstrated that T wave inversion was deeper and QTc interval longer in patients with TTC than in subjects with minimal AMI. Moreover, they described a similar time-course of the ECG changes between the two conditions. Conversely, Mitsuma et coll.13 demonstrated that TTC consisted in 4 ECG phases. Phase 1 showed STE; in phase 2 T-wave inversion appears after ST-segment elevation; phase 3 was described as a transient improvement in T-wave inversion while phase 4 showed a second, deeper T-wave inversion in the long term. Despite the interesting findings of the study, only nine patients were enrolled, so these results must be confirmed on larger sample. However, some case reports have confirmed this time course. 14,15 A partial agreement (phase 1 and 2), was observed by Inoko and coll, 16 which described a TTC after subarachnoidal hemorrhage (SAH), but the patient died after 5 days and ECG time course could not be completely confirmed. Thakar and coll.17 evaluate daily ECG changes during the first week of hospitalization in patients with TTC. They described absence of STE elevation in V1, pathological Q waves in about half of the patients, QTc interval prolongation in 90% of cases and T wave inversion in all subjects. Looi and coll described ECG changes observed in TTC within two days of presentation. 18 The aim of their study was to describe the evolution of ECG in TTC compared with those observed in AMI. They reported STE in 35% of patients at admission and, compared to STEMI, they observed a less prominent STE in TTC. Moreover, on second da...

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A New Electrocardiographic Criterion to Differentiate Between Takotsubo Cardiomyopathy and Anterior Wall ST-Segment Elevation Acute Myocardial Infarction

Cited by 33 publications

References 15 publications

ST-segment deviation pattern of takotsubo cardiomyopathy similar to acute pericarditis: Diffuse ST-segment elevation

ST-segment deviation pattern of takotsubo cardiomyopathy similar to acute pericarditis: Diffuse ST-segment elevation

Can Acute Myocardial Infarction Sneak Out From Takotsubo?

Takotsubo cardiomyopathy: which role for serial electrocardiogram changes?

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