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Takotsubo cardiomyopathy: diagnosis in an emergency department

Marina Mancini, Davide Bartolini, Mauro Zanna
  • Marina Mancini
    Department of Emergency Medicine, Villa Scassi Hospital, Local Health Unit 3, Genoa, Italy | mauro.zanna@villascassi.it
  • Davide Bartolini
    Department of Cardiology, Villa Scassi Hospital, Local Health Unit 3, Genoa, Italy
  • Mauro Zanna
    Chief Medical Officer, Life Support Camp of Al Zubair, Basrah, Iraq

Abstract

Takotsubo cardiomyopathy (TC) is a reversible cardiomyopathy characterized by transient wall-motion abnormalities of the left ventricle (LV) in the absence of significant obstructive coronary disease. In emergency departments the diagnosis remains a challenge because clinical and electrocardiographic presentation of Takotsubo is quite similar to ST-segment elevation myocardial infarction. We conducted a retrospective descriptive study on 1654 patients admitted to our emergency department from 2006 to 2009 who had a left heart catheterization for a suspected acute coronary syndrome and among them we evaluated characteristics on admission of 14 patients with a clinical picture suggestive for a TC. All patients were postmenopausal female. Ten patients (71%) had preceding stressful events and four patients (29%) did not have identifiable stressors. Thirteen patients (93%) presented chest pain and one (7%) syncope. ST-segment elevation was present in six patients (43%). One patient (7%) presented an episode of ventricular fibrillation. All patients presented increased cardiac Troponin T. Initial LV ejection fraction, evaluated by transthoracic echocardiography was 44±10%. Follow-up LV ejection fraction was 61±10%. Six patients (43%) had characteristic apical ballooning and eight patients (57%) had hypokinesia or akinesia of the apical or/and midventricular region of the LV without ballooning. Coronary angiography was normal in nine patients (64%) and five (36%) had stenosis <50%. None had complete obstruction of a coronary. Takotsubo syndrome should be considered as a possible diagnosis in patients admitted in an emergency department with a suspected diagnosis of acute coronary syndrome. Emergency physicians should recognize salient aspects of the medical history at presentation in order to organize appropriate investigations and avoid inappropriate therapies.

Keywords

Takotsubo cardiomyopathy, acute myocardial infarction, reversible left ventricular ballooning, emergency department

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Submitted: 2013-02-15 16:48:57
Published: 2014-06-30 12:59:43
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Copyright (c) 2014 Marina Mancini, Davide Bartolini, Mauro Zanna

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