Takotsubo Syndrome in the Emergency Room — Diagnostic Challenges and Suggested Algorithm

Abstract

Takotsubo syndrome is an important condition to consider among patients with acute chest pain in the emergency room. It often mimics acute coronary syndrome since chest pain and ECG changes are key features in both conditions. The hallmark of takotsubo syndrome is transient left ventricular dysfunction (characterized by apical ballooning) followed by complete echocardiographic recovery in most cases. Although most patients exhibit a benign course, lethal complications may occur. The use of hand-held point-of-care focused cardiac ultrasound may be helpful for early identification of takotsubo syndrome and distinguishing it from acute coronary syndrome and other cardiovascular emergencies. Emergency room physicians should be familiar with typical and atypical presentations of takotsubo syndrome and its key electrocardiographic changes. The approach in the emergency room should be based on a combination the clinical presentation, ECG, and handheld echocardiography device findings, rather than a single electrocardiographic algorithm.

Case report: Takotsubo syndrome following percutaneous coronary intervention

“…This case also reminds us that when patients after PCI experience unexplained electrocardiogram changes and elevated troponin, we cannot ignore the possibility of TTS while considering the complications after PCI. Additionally, TTS caused by emotional stimulation is not rare, especially under the in uence of negative emotional events [10][11][12]. In the perioperative period of patients receiving interventional therapy, good physician-patient communication is particularly signi cant.…”