Takotsubo syndrome in African-American women with atypical presentations: a single-center experience.
BACKGROUND
Takotsubo syndrome is comprised of the clinical presentation of an acute myocardial infarction with electrocardiographic (ECG) changes of acute ischemia, chest pain, positive biomarkers, a pathognomonic left ventricular apical wall motion abnormality, and no culprit coronary disease at cardiac catheterization.


OBJECTIVE
This study aimed at a further definition of the clinical characteristics of this syndrome in African-American (AA) patients based on our experience at a single center.


METHODS
Patients who presented with this syndrome between June 2003 and June 2005 were evaluated. All patients underwent coronary angiography and noninvasive cardiac investigation, including transthoracic two-dimensional echocardiography.


RESULTS
Five AA women (mean age 65 years) presented with the characteristics of the syndrome. No patient experienced chest pain, with three presenting with shortness of breath and two with nausea. Hypertension was the most common risk factor for coronary artery disease (CAD) in these patients. All but one patient had ST elevation on ECG, and troponin I elevation was present in all. Cardiac catheterization showed no obstructive CAD. The most common trigger was exacerbation of a current medical condition. All five patients developed deep, broad, diffuse T-wave inversions with a prolonged QT interval. There was no mortality during the hospital stay.


CONCLUSIONS
Takotsubo syndrome is experienced by AA patients. Female AA patients may experience atypical symptoms at presentation. The development of broad, diffuse, T-wave inversions with a prolonged QT interval within 2-48 h of presentation should be considered an additional criterion when diagnosing Takotsubo syndrome.
Patel
Himanshu M
HM
Department of Cardiology, Albert Einstein Medical Center, 5501 Old York Road, Philadelphia, PA 19104, USA.
Kantharia
Bharat K
BK
Morris
D Lynn
DL
Yazdanfar
Shahriar
S
D001741:Black or African American; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002637:Chest Pain; D017023:Coronary Angiography; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000208:ethnology; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000208:ethnology; D013577:Syndrome; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis* / Q000208:ethnology
D015415:Biomarkers