Author(s): von Korn H, Yu J, Lotze U, Ohlow MA, Huegl B
OBJECTIVES: A newly discovered heart syndrome mimicking acute coronary syndrome has been termed 'Tako-Tsubo cardiomyopathy' (TTC). Differentiation from acute myocardial infarction using the ECG is an important issue in clinical practice.
METHODS: We retrospectively analyzed patients admitted for cardiac catheterization between September 2003 and September 2006.
RESULTS: From 26,593 cardiac catheterization procedures, we identified 21 patients with suggested TTC (0.08\%). Trigger mechanisms were present in 38.1\%; all patients had elevated troponin levels (mean 3.9 ng/ml). Median age was 68.4 years; 90.5\% were female. Hypertension was seen in 85.7\% and atrial fibrillation in 19.1\%. Specific ECG findings related to a TTC are: a mild elevation of the ST segment arising from the S curve of the QRS complex, where the maximum ST segment elevation at the basis of the T wave is <1.5 mm, T-wave inversion, absence of ST segment depression and a summated amplitude of the S curve in V1 plus R in V6 <1.5 mV. An intraventricular gradient was seen in 9.5\%; coronary atherosclerosis was detected in 57.1\%. Follow-Up Data: Mean follow-up was 13.2 months. 47.6\% were free from angina or dyspnea, most of the patients received beta-blockers/ACE inhibitors (76.2\%). One patient had a sudden cardiac death (4.8\%), 1 patient became an implantable cardioverter-defibrillator primarily due to resuscitation.
CONCLUSION: TTC is a rare syndrome mimicking acute coronary syndrome that shows a specific ECG pattern and does not appear to be an unambiguously benign disease. Copyright 2008 S. Karger AG, Basel.Journal of Anesthesia & Clinical Research