Not Such a Rarity! Takotsubo Cardiomyopathy as a Mimic of ST Elevation Myocardial Infarction

Abstract

Purpose: Takotsubo Cardiomyopathy (TTC) was initially thought to be a rare disorder predominantly presenting like ST elevation myocardial infarction (STEMI). However, recent data suggests that TTC may occur relatively commonly, especially among ageing women, and STEMI-like changes may not represent the major mode of presentation of TTC. We therefore sought to evaluate (1) the incidence of STEMI- like TTC among women > 50 years (2) the proportion of recognized TTC cases presenting as STEMI. Methods: Four years' data from 2 major tertiary referral hospitals were audited. Diagnosis of TTC was based on (1) typical left ventricular wall motion anomalies (2) exclusion of myocardial infarction, and (3) demonstration of typical inflammatory changes. Results: During the period concerned 1,426 patients presented as including 343 women of whom 98% were >50 years old. TTC was diagnosed in 9.3% of women older than 50 years presenting with STEMI. Of the total TTC cases over four years, 29 women (26%) presented as STEMI. Despite the relatively stable prevalence of TTC, the proportion of TTC cases mimicking STEMI increased over the evaluation period (Figure). Presentation with STEMI-like TTC was also associated with marginally greater extensive wall motion anomalies (p=0.07) and similar NT pro BNP release. ![Figure][1] Figure 1 Conclusion: (1) Presentation of TTC occurs more frequently without ST elevation. (2) Among women >50 years presenting with STEMI, TTC accounts for approximately 9.3% of cases. Therefore improved diagnostic algorithms for earlier diagnosis of the subset are required. [1]: pending:yes