Coronary artery diseaseSpectrum and Significance of Electrocardiographic Patterns, Troponin Levels, and Thrombolysis in Myocardial Infarction Frame Count in Patients With Stress (Tako-tsubo) Cardiomyopathy and Comparison to Those in Patients With ST-Elevation Anterior Wall Myocardial Infarction
Section snippets
Methods
From August 2001 to April 2006, 59 consecutive patients with SC presented to the Minneapolis Heart Institute at Abbott Northwestern Hospital. All patients were women, ranging in age from 32 to 90 years (mean 66 ± 13). These patients demonstrated the following features: (1) an acute cardiac event typically presenting with substernal chest discomfort, (2) systolic dysfunction with akinesia or hypokinesia of the mid and distal left ventricular (LV) chamber associated with a hypercontractile basal
Results
The distribution of initial ECG diagnostic patterns was as follows: ST elevation, most common in leads V2 and V3 (n = 33 [56%]); widespread T-wave inversion (n = 10 [17%]); healed anterior infarctions (n = 6 [10%]); nonspecific (n = 5 [8.5%]); and normal (n = 5 [8.5%]) (Figure 1, Figure 2). Patients with or without ST elevation did not differ with regard to the ejection fraction (29 ± 9% vs 34 ± 9%, respectively) or the presence of apical sparing (9 of 33 [27%] vs 10 of 26 [38%], respectively).
Discussion
Previously, we1 and others5, 8, 9, 10, 14 have underscored the importance of differentiating SC from the much more common acute anterior wall myocardial infarction, particularly because it has been emphasized that the 2 conditions may present with ST-segment elevation pattern on initial electrocardiography. However, previous reports are conflicting with respect to the frequency of ST elevation reported in this condition. In a number of reports from Japan2, 5, 10 and elsewhere,7, 8, 15, 16, 17
Acknowledgment
We acknowledge Dr. Morrison Hodges for his helpful insights.
References (23)
- et al.
Transient left ventricular apical ballooning without coronary artery stenosis: a novel heart syndrome mimicking acute myocardial infarction. Angina Pectoris-Myocardial Infarction Investigations in Japan
J Am Coll Cardiol
(2001) - et al.
Electrocardiography cannot reliably differentiate transient left ventricular apical ballooning syndrome from anterior ST-segment elevation myocardial infarction
J Electrocardiol
(2007) - et al.
Tako-tsubo-like left ventricular dysfunction with ST-segment elevation: a novel cardiac syndrome mimicking acute myocardial infarction
Am Heart J
(2002) - et al.
Electrocardiographic observations in severe aortic valve stenosis: correlative necropsy study to clinical, hemodynamic, and ECG variables demonstrating relation of 12-lead QRS amplitude to peak systolic transaortic pressure gradient
Am Heart J
(1982) - et al.
Transient midventricular ballooning syndrome: a new variant
J Am Coll Cardiol
(2006) - et al.
Clinical characteristics and thrombolysis in myocardial infarction frame counts in women with transient left ventricular apical ballooning syndrome
Am J Cardiol
(2004) - et al.
Myocardial perfusion in apical ballooning syndrome correlate of myocardial injury
Am Heart J
(2006) - et al.
Intracranial hemorrhage in association with thrombolytic therapy: incidence and clinical predictive factors
J Am Coll Cardiol
(1992) - et al.
Reversible myocardial contraction abnormalities in patients with an acute noncardiac illness
Chest
(1998) - et al.
Transient pathologic Q waves during acute ischemic events: an electrocardiographic correlate of stunned but viable myocardium
Am Heart J
(1983)
Acute and reversible cardiomyopathy provoked by stress in women from the United States
Circulation
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This study was supported in part by the Minneapolis Heart Institute Foundation, Minneapolis, Minnesota; the National Heart Foundation of New Zealand, Auckland, New Zealand; and the Waikato Heart Trust, Hamilton, New Zealand.