From the Guidelines
Takotsubo cardiomyopathy is diagnosed through a combination of clinical presentation, cardiac imaging, and laboratory tests, with the definitive diagnosis coming from cardiac imaging, particularly echocardiography or cardiac catheterization, which shows the characteristic "ballooning" of the left ventricle with apical akinesis or dyskinesis and basal hyperkinesis, as described in the European Heart Journal study 1. The diagnosis typically begins with an evaluation of symptoms, which often mimic a heart attack, including chest pain and shortness of breath. An electrocardiogram (ECG) usually shows abnormalities such as ST-segment elevation or T-wave inversions. Blood tests will reveal elevated cardiac biomarkers like troponin, though typically not as high as in a true heart attack. Importantly, coronary angiography must demonstrate no significant coronary artery obstruction that could explain the wall motion abnormalities. A recent emotional or physical stressor is often identified as a trigger. The Mayo Clinic diagnostic criteria are commonly used, requiring all of the following: transient left ventricular dysfunction, absence of obstructive coronary disease, new ECG abnormalities or modest elevation in cardiac troponin, and absence of pheochromocytoma or myocarditis, as outlined in the study 1. These diagnostic steps help differentiate takotsubo cardiomyopathy from acute coronary syndrome and other cardiac conditions. Some key points to consider in the diagnosis of takotsubo cardiomyopathy include:
- The use of echocardiography to assess changes in LV function, such as symmetric regional wall motion abnormalities (RWMAs) 1.
- The importance of cardiac magnetic resonance imaging (CMR) in the subacute phase to identify typical RWMAs, assess additional abnormalities, and characterize myocardial tissue 1.
- The role of coronary angiography in ruling out obstructive coronary disease 1.
- The consideration of prophylactic anticoagulation to prevent the development of LV thrombi, as suggested in the study 1. Overall, the diagnosis of takotsubo cardiomyopathy requires a comprehensive approach, incorporating clinical presentation, cardiac imaging, and laboratory tests, with a focus on differentiating it from other cardiac conditions, as emphasized in the study 1.
From the Research
Diagnostic Approaches
- Takotsubo cardiomyopathy is diagnosed using a combination of imaging techniques and clinical criteria, including the Mayo diagnostic criteria 2.
- Invasive coronary angiography and ventriculography are considered the 'gold standard' for definitive diagnosis 3.
- Echocardiography is a widely available, first-line, non-invasive imaging technique used to confirm diagnosis, assess potential complications, and track myocardial recovery 3.
- Cardiac magnetic resonance (CMR) imaging may be helpful in discriminating Takotsubo cardiomyopathy from other acute cardiac syndromes with troponin elevation and ventricular dysfunction 3, 4.
Imaging Techniques
- Transthoracic echocardiography is used to demonstrate wall-motion abnormalities that extend beyond the territory of a single epicardial coronary artery 4, 5.
- Cardiac magnetic resonance imaging (CMR) is used to assess ventricular function and rule out other causes of cardiomyopathy 3, 4.
- Coronary angiography is used to exclude obstructive coronary artery disease 3, 4, 5.
- Left ventriculogram is used to assess left ventricular function and wall motion abnormalities 4.
Clinical Criteria
- The Mayo diagnostic criteria are used to diagnose Takotsubo cardiomyopathy, which includes transient left ventricular wall dysfunction, absence of obstructive coronary artery disease, and presence of wall-motion abnormalities extending beyond the territory of a single epicardial coronary artery 2.
- Clinical presentation typically involves chest pain and/or dyspnea, transient ST-segment elevation on the electrocardiogram, and a modest increase in cardiac troponin 5, 6.