title: Electrocardiographic changes in Takotsubo cardiomyopathy.
abstract: BACKGROUND
  Takotsubo cardiomyopathy (TC) is a unique transient nonischemic cardiomyopathy that mimics acute myocardial infarction (MI). The aim of our study was to evaluate electrocardiographic changes in patients with TC, including the frequency of ST elevation and other abnormalities.
  
  
  METHODS
  Eleven patients were retrospectively identified from echocardiography database. All patients underwent coronary angiography and fulfilled the Mayo criteria for diagnosis of TC during the period November 2005 to September 2010. Standard 12-lead electrocardiograms recorded daily during the first week of hospitalization, after onset of symptoms were analyzed.
  
  
  RESULTS
  Eight of 11 patients were found to have ST elevation, of which two patients had ST depression in reciprocal leads. No patient had ST elevation in lead V1, most likely reason being that wall-motion abnormalities in TC rarely extend to the region faced by lead V1. Pathological Q waves were found in five patients, of which two patients had transient Q waves, suggesting less myocardial damage. All 11 patients had T-wave inversion; eight of these patients had diffuse symmetric T-wave inversion, extending beyond the perfusion territory of any single coronary artery. QTc interval prolongation was found in 10 patients. All patients had left ventricular ejection fraction between 25% and 35% on presentation, which could not be predicted by the extent of electrocardiogram (ECG) changes.
  
  
  CONCLUSIONS
  ECG changes in TC are distinctive and differ from those typically seen in acute anterior MI. The ECG abnormalities described may be important clues for the clinician to suspect diagnosis of TC in the right clinical setting.
authors.affiliation: Department of Internal Medicine Division of Cardiology Clinical Cardiology Department of Internal Medicine, Maimonides Medical Center, Brooklyn, NY 11219, USA. saurabhthakar@rediffmail.com
authors.forename: Saurabh
authors.initials: S
authors.lastname: Thakar
authors.forename: Preeti
authors.initials: P
authors.lastname: Chandra
authors.forename: Gerald
authors.initials: G
authors.lastname: Hollander
authors.forename: Edgar
authors.initials: E
authors.lastname: Lichstein
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000503:physiopathology; D012189:Retrospective Studies; D013318:Stroke Volume / Q000502:physiology; D054549:Takotsubo Cardiomyopathy / Q000175:diagnosis / Q000503:physiopathology*