The early dynamic of ECG in takotsubo syndrome presenting with ST-elevation: A comparison with age and gender-matched ST-elevation myocardial infarction

Scally, Caroline; Choo, WaiKah; Rudd, Amelia; Neil, Christopher; Siddiqi, Nishat; Mezincescu, Alice; Frenneaux, Michael; Horgan, Graham; Broadhurst, Paul; Dawson, Dana

doi:10.1016/j.ijcard.2020.09.023

Cited by 4 publications

(7 citation statements)

References 20 publications

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“…36 Stage 2 involves progressive deep T-wave inversion and QTc prolongation, occurring within 1 to 3 days and peaking at 2 to 6 days, although when corrected for sex, the QTc is not different from male patients with acute myocardial infarction. 37 These T-wave inversions are usually widespread over the precordial (V 1 through V 6 ), bipolar (I, II), and lateral limb (aVL) leads and correlate with myocardial edema, which can persist beyond ventricular contractile recovery. 36 During these first 24 to 48 hours, torsade de pointes and other ventricular tachycardias can occur.…”

Section: Investigationsmentioning

confidence: 99%

Takotsubo Syndrome: Pathophysiology, Emerging Concepts, and Clinical Implications

et al. 2022

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Takotsubo syndrome is a condition characterized by acute transient left ventricular systolic dysfunction, which at presentation can be challenging to distinguish from acute myocardial infarction. Although previously thought to be a benign, self-limiting condition, recent studies have confirmed that patients with takotsubo syndrome have persistent subtle ongoing cardiac dysfunction, and many continue to have limiting symptoms despite restoration of left ventricular ejection fraction. Moreover, these patients have a substantial burden of morbidity and mortality, as well, with high rates of subsequent major adverse cardiovascular events that approach those of patients with acute coronary syndrome. The mechanisms behind this condition remain elusive. Despite substantial research, the medical community continues to have an incomplete understanding of its underlying pathogenesis and pathophysiology. Catecholamine-induced myocardial injury is the most established and well-known theory, but this does not explain all the clinical features and presentations of the condition, and numerous other pathways and abnormalities are emerging. Because of the poor understanding of its underlying pathophysiology, there is a lack of evidence-based interventions to treat the acute episode, to avoid recurrences, and to prevent major adverse cardiovascular events. This highlights the need for further research to gain a better understanding of the underlying pathophysiology to inform appropriate randomized controlled trials of interventions targeting the causative pathways. Only then can evidence-based management strategies be established to improve clinical outcomes of this potentially lethal condition.

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Section: Investigationsmentioning

confidence: 99%

Takotsubo Syndrome: Pathophysiology, Emerging Concepts, and Clinical Implications

et al. 2022

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“…The study gives the ECG monitoring system characteristics, relationship, and challenges used to optimize ECG system performance. Therefore, a general architectural model of an ECG monitoring system is proposed, and a comprehensive analysis of the value chain of the ECG monitoring system is performed [5,6]. Finally, key challenges were identified, and the importance of smart surveillance systems was highlighted, which utilizes artificial intelligence (AI), deep learning (DL), Internet of Things (IoT), and big data techniques widely utilized to create effective systems [7].…”

Section: Introductionmentioning

confidence: 99%

Application Value of Remote ECG Monitoring in Early Diagnosis of PCI for Acute Myocardial Infarction

Zhou

2022

BioMed Research International

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The blockage of blood in the vessels results in heart attacks and cardiac arrests which are referred to as myocardial infarction. Early detection of such infarction is feasible through percutaneous coronary intervention (PCI) based on electrocardiogram (ECG) monitoring. The variations in blood flow and clot are precisely observed through periodic ECG monitoring and previous correlations. This article introduces a concentrated value assessment model (CVAM) for determining PCI levels in treating myocardial infarction. The ECG observations from the previous observation sessions are accumulated and organized for validating the infarction rate. This requires the accompanying concentrated data like a heartbeat, blood pressure, and flow rate observed in different sessions. Based on the session observation and normal data correlation, the PCI level is recommended for the patient. In this analysis process, the value shift due to blocks and high and low blood pressure is accounted for through the deep learning paradigm. This paradigm correlates the above factors with the ECG values for precisely determining PCI from the last known concentration. The learning paradigm is trained based on session and normal observation data through different intervals. This model is validated using the metrics precision, analysis rate, diagnosis recommendation, and complexity.

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“…and anterior myocardial infarction. 3,4,5,6,11 Significant differences have been described with regard to distribution of ST-segment elevation in the precordial leads, V1 and aVR involvement, reciprocal ST-segment changes in the inferior leads, evidence of Q wave, QT lengthening, T wave inversion.…”

Section: Several Studies Have Compared St-segment Changes In Typical Ttsmentioning

confidence: 99%

“…Various ECG criteria to distinguish a TTS from an AMI have previously been proposed 3,4 but frequent overlapping of ECG changes between the two conditions limits the predictive value of these indexes. 5,6 In the typical form of TTS with apical involvement, transthoracic echocardiography shows akinesis of the whole apex extending to the mid segments of the left ventricle in a circumferential pattern, beyond the territory of distribution of the left descending coronary artery (LAD). Cases of extensive anterior STEMI can frequently mimic TTS,…”

Section: Introductionmentioning

confidence: 99%

Differentiating typical Tako‐tsubo syndrome from extensive anterior STEMI: Look behind the anterior wall

et al. 2022

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Background: Tako-tsubo syndrome (TTS) in its most typical form shares common features with anterior ST-segment elevation myocardial infarction (AMI) during acute presentation. Differential diagnosis between the two conditions is often challenging especially if ST-segment elevation is associated with extensive apical akinesis. Methods:We sought to systematically analyze ECG and echocardiographic parameters including LV longitudinal strain and two new indexes: the inferior-apex ratio (IAR) and the inferior-lateral-apex ratio (ILAR), to assess if ventricular involvement may be different in TTS and AMI.Results: A retrospective cohort study was conducted with two groups: patients with TTS (n = 22) and patients with extensive anterior STEMI (n = 22). Lack of ST elevation in V1 was associated with TTS with sensitivity and specificity of 86%, positive and negative predictive value of 86%. Longitudinal strain in mid inferior and mid inferiorlateral segments were more compromised in TTS: −4.3 ± 6.4% and −5.4 ± 5.4% in TTS versus −10.2 ± 5.5% and −9.9 ± 4.9% in AMI, respectively (p < .01 for all). By multivariate analysis, both longitudinal strain values, inferior-apical ratio (IAR) < 1 and inferior-lateral-apical ratio (ILAR) < 1 were independently associated with diagnosis of TTS during acute phase. Conclusions:Our results suggest that impaired contractility extending beyond apex to mid inferior and inferior-lateral walls can be easily assessed by IAR and ILAR, and these indexes facilitate non-invasive differentiation of TTS from extensive anterior STEMI.

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The early dynamic of ECG in takotsubo syndrome presenting with ST-elevation: A comparison with age and gender-matched ST-elevation myocardial infarction

Cited by 4 publications

References 20 publications

Takotsubo Syndrome: Pathophysiology, Emerging Concepts, and Clinical Implications

Takotsubo Syndrome: Pathophysiology, Emerging Concepts, and Clinical Implications

Application Value of Remote ECG Monitoring in Early Diagnosis of PCI for Acute Myocardial Infarction

Differentiating typical Tako‐tsubo syndrome from extensive anterior STEMI: Look behind the anterior wall

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