Takotsubo cardiomyopathy mimics an acute coronary syndrome in postmenopausal women

Salvatore Azzarelli, Damiana Fiscella, Giuseppe Grosso, Francesco Amico, Michele Giacoppo, Vincenzo Argentino, Antonio Fiscella, Roxana Mehran, George Dangas

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1 Scopus citations


Objective: Takotsubo cardiomyopathy (TC) is characterized by transient regional systolic dysfunction in the absence of atherosclerotic coronary artery disease, usually occurred in post-menopausal women and triggered by emotional or physical stress. The clinical presentation is indistinguishable from an acute coronary syndrome (ACS). The aim of the current study was to prospectively assess prevalence clinical features, and long-term follow-up of consecutive patients with TC. Methods: We identified 19 consecutive patients with TC. This group represents the 1% of 1,880 patients admitted with a suspected ACS over a 4-year period. Results: Seventeen patients (89%) were postmenopausal women. Mean age was 65 ± 13 years, median age 66, range 33 to 84. A preceding strong emotional stress was present in 9 patients (47%), and 5 patients (26%) developed symptoms after physical stress. Eighteen patients (95%) had chest pain as presenting symptom. Nine patients (47%) had significant ST-segment elevation in ≥ 2 contiguous leads, whereas the other 10 patients (53%)) had T-wave inversion on their admission electrocardiograms. The maximum corrected QT interval calculated using Bazett's formula was prolonged (> 440 ms, mean 455 ± 41). Mean peak troponin I was 4.3 ± 5 ng/dl (limit of normal ≤0.5). The mean echocardiographic ejection fraction was 40 ± 8% (range 22% to 55%) on admission, and increased significantly at discharge and at 1-month follow-up. We observed one case of mid-ballooning without apical involvement. Seventeen patients (89%) had significantly abnormal TIMI frame counts, a marker of altered myocardial perfusion. During the index hospitalization, 6 patients (31%) had clinical complications (one cardiogenic shock, 4 congestive heart failure, and one apical thrombus formation). Major adverse cardiac events were not observed at a mean follow -up of 23 ± 11 months. Although the recurrence of TC was not observed, 4 patients (21%) continued to experience episodes of chest pain. Conclusion: TC have a clinical presentation that is largely indistinguishable from ACS. This pathology, which occurred 1% of the patients presenting with a suspected ACS in our series, should he highly considered in a postmenopausal woman with history of profound stress, new ST-segment changes and a limited rise in troponin.

Original languageEnglish
Pages (from-to)126-131
Number of pages6
JournalJournal of Chinese Clinical Medicine
Issue number3
StatePublished - 2009
Externally publishedYes


  • Acute coronary syndrome
  • Takotsubo cardiomyopathy
  • Transient left ventricular apical ballooning


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