title: Plausible mechanisms of the rapid conversion of ST-segment elevation to T-wave inversion in Takotsubo syndrome.
abstract: Takotsubo syndrome (TTS) is characterized by electrocardiogram (ECG) diffuse ST-segment elevations (+ST), and T-wave inversions with prolongation of the QTc interval. Thus ECG-wise, TTS is not different from acute coronary syndromes (ACSs). However unlike acute ST-elevation myocardial infarction, one type of ACS, a rapid conversion of+ST to T-wave inversion with prolongation of the QTc interval is seen in TTS. The author hypothesizes that this conversion is paralleled by a change of segmental myocardial dyskinesis to akinesis, development of myocardial edema, and reversion of the cardioinhibitory ß-2 adrenergic receptor function, to its cardiostimulatory normal status. This hypothesis does not negate the plausibility that the ECG changes in TTS are due to myocardial ischemia/injury as traditionally perceived in ACSs. The reasons of the counterintuitive concurrence of the cardiac contractility to normal, or previous baseline status, while myocardial edema and T-wave inversions persist for several weeks in patients with TTS, are still elusive.
authors.affiliation: Icahn School of Medicine at Mount Sinai of the New York University, Division of Cardiology, Elmhurst Hospital Center, New York, NY, USA. Electronic address: madiasj@nychhc.org.
authors.forename: John E
authors.initials: JE
authors.lastname: Madias
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D017023:Coronary Angiography; D018450:Disease Progression; D004562:Electrocardiography; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D054549:Takotsubo Cardiomyopathy / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology
keywords: Left ventricular wall motion abnormalities; QTc prolongation; ST-elevation; T-wave inversion; Takostubo syndrome; Ventricular aneurysm