Diagnostics

• ↑ Troponin T/I

• ↑ Creatine kinase-MB

• ↑ BNP

ECG is abnormal in > 95% of patients with takotsubo cardiomyopathy and usually shows ischemic changes. [1]

• ST elevations (most common finding), typically in the precordial leads

• ST depressions are uncommon (< 10% of cases).

• Diffuse T-wave inversions

• Prolonged QT interval

• Indications: all patients suspected of having takotsubo cardiomyopathy

• Supportive findings

  • ↓ LVEF

  • Global LV dyskinesis involving the apex (most common)

  • Regional wall motion abnormalities

    • Apical left ventricular ballooning (not always present)

    • More rarely, midventricular ballooning (10–20% of cases) or basal ballooning (< 5% of cases) may be present [1]

  • LVOT obstruction may be present (up to 25% of cases) [1]

(with ventriculography) [2]

• Indications: to exclude ACS

• Findings

  • Most cases: normal coronary arteries or nonobstructive coronary artery disease

  • ∼ 15% of cases: obstructive coronary artery disease may also be present

• Indications

  • To exclude differential diagnoses (e.g., myocarditis) and confirm the diagnosis of takotsubo cardiomyopathy in stable patients

  • Allows for better imaging of the right ventricle

• Suggestive findings

  • Similar to findings in TTE

  • Transmural edema along the areas of wall motion abnormalities

  • Myocardial scarring

• Possible additional findings

  • LVOT obstruction

  • Valve disease

  • Pericardial effusion

  • LV thrombus

consider as an alternative for stable patients with contraindications to cMRI to exclude high-grade coronary stenosis

• Acute coronary syndrome

• Acute myocarditis

• See differential diagnosis of chest pain.