Takotsubo cardiomyopathy as a differential diagnosis of acute coronary syndrome: differences between clinical features

Authors

DOI:

https://doi.org/10.33448/rsd-v11i2.25514

Keywords:

Takotsubo cardiomyopathy; Acute coronary syndrome; Differential diagnosis; Clinical manifestations.

Abstract

Objective: To demonstrate the importance of having Takotsubo Cardiomyopathy (TC) as a differential diagnosis for acute coronary syndrome (ACS), through the analysis of the clinical aspects of this condition. Methods: Integrative literature review that sought to answer the question "How is the diagnosis of patients with Takotsubo cardiomyopathy, differentiating from Acute Coronary Syndrome, based on the clinical presentation?", developed through the PICo strategy and whose articles were searched in the databases sources: Medical Literature and Retrieval System onLine (MEDLINE/PubMed®) via National Library of Medicine; Scientific Electronic Library Online (SciELO) and Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS). Results: Patients with TC were predominantly women, with a mean age between 60 and 70 years in more than 90% of the cases and they presented similarities to ACS, which presents a challenge in differentiating the two. The clinical pictures are similar due to the presence of chest pain and dyspnea, including changes in the ECG and cardiac biomarkers, in addition to presenting similar data on mortality and in-hospital complications. Electrocardiographic alterations, although present in both conditions, present different patterns. Conclusion: The two conditions, TC and ACS, have very similar clinical presentations, and the first should be investigated as a differential diagnosis of the second. For the differentiation of the two and diagnostic confirmation of Takotsubo cardiomyopathy, the Mayo criteria must be considered, through the help of complementary exams, such as electrocardiogram and echocardiography.

References

Ahmed, K. A., Madhavan, M., & Prasad, A. (2012). Brain natriuretic peptide in apical ballooning syndrome (Takotsubo/stress cardiomyopathy): comparison with acute myocardial infarction. Coronary artery disease, 23(4), 259-264.

Botelho, L. L. R., de Almeida Cunha, C. C., & Macedo, M. (2011). O método da revisão integrativa nos estudos organizacionais. Gestão e sociedade, 5(11), 121-136.

Cai, L., Addetia, K., Medvedofsky, D., & Spencer, K. T. (2017). Myocardial strain may be useful in differentiating Takotsubo cardiomyopathy from left anterior descending coronary artery ischemia. International journal of cardiology, 230, 359-363.

Dias, A., Franco, E., Mercedes, A., Hebert, K., Messina, D., & Quevedo, H. C. (2013). Clinical features of takotsubo cardiomyopathy-a single-center experience. Cardiology, 126(2), 126-130.

Eitel, I., von Knobelsdorff-Brenkenhoff, F., Bernhardt, P., Carbone, I., Muellerleile, K., Aldrovandi, A., Francone, M. et al. (2011). Clinical characteristics and cardiovascular magnetic resonance findings in stress (takotsubo) cardiomyopathy. Jama, 306(3), 277-286.

Frangieh, A. H., Obeid, S., Ghadri, J. R., Imori, Y., D'Ascenzo, F., Kovac, M., Ruschitzka, M. et al. (2016). ECG criteria to differentiate between Takotsubo (stress) cardiomyopathy and myocardial infarction. Journal of the American Heart Association, 5(6), e003418.

Fröhlich, G. M., Schoch, B., Schmid, F., Keller, P., Sudano, I., Lüscher, T. F., Noll, G. et al. (2012). Takotsubo cardiomyopathy has a unique cardiac biomarker profile: NT-proBNP/myoglobin and NT-proBNP/troponin T ratios for the differential diagnosis of acute coronary syndromes and stress induced cardiomyopathy. International journal of cardiology, 154(3), 328-332.

Ghadri, J. R., Cammann, V. L., Jurisic, S., Seifert, B., Napp, L. C., Diekmann, J., Bataiosu, D. R. et al. (2016). A novel clinical score (InterTAK Diagnostic Score) to differentiate takotsubo syndrome from acute coronary syndrome: results from the International Takotsubo Registry. European journal of heart failure, 19(8), 1036-1042.

Ghadri, J. R., Kato, K., Cammann, V. L., Gili, S., Jurisic, S., Di Vece, D., Candreva, A. et al. (2018). Long-term prognosis of patients with Takotsubo syndrome. Journal of the American College of Cardiology, 72(8), 874-882.

Jaguszewski, M., Osipova, J., Ghadri, J. R., Napp, L. C., Widera, C., Franke, J., Fijalkowski, M. et al. (2014). A signature of circulating microRNAs differentiates takotsubo cardiomyopathy from acute myocardial infarction. European heart journal, 35(15), 999-1006.

Kim, H., Senecal, C., Lewis, B., Prasad, A., Rajiv, G., Lerman, L. O., & Lerman, A. (2018). Natural history and predictors of mortality of patients with Takotsubo syndrome. International journal of cardiology, 267, 22-27.

Laghari, A. H., Khan, A. H., & Kazmi, K. A. (2014). Takotsubo cardiomyopathy: ten year experience at a tertiary care hospital in Pakistan. BMC research notes, 7(1), 1-5.

Lee, S. R., Lee, S. E., Rhee, T. M., Park, J. J., Cho, H., Lee, H. Y., Choi, D. J. et al. (2017). Discrimination of stress (Takotsubo) cardiomyopathy from acute coronary syndrome with clinical risk factors and coronary evaluation in real-world clinical practice. International journal of cardiology, 235, 154-161.

Looi, J. L., Poppe, K., Lee, M., Gilmore, J., Webster, M., To, A., & Kerr, A. J. (2020). A Score to differentiate Takotsubo syndrome from non-ST-elevation myocardial infarction in women at the bedside. Open heart, 7(1), e001197.

Medeiros, K., O’Connor, M. J., Baicu, C. F., Fitzgibbons, T. P., Shaw, P., Tighe, Zile, M. R. et al. (2014). Systolic and diastolic mechanics in stress cardiomyopathy. Circulation, 129(16), 1659-1667.

Meissner, J., Nef, H., Darga, J., Kovacs, M., Weber, M., Hamm, C., Möllmann, H. et al. (2011). Endogenous stress response in Tako‐Tsubo cardiomyopathy and acute myocardial infarction. European journal of clinical investigation, 41(9), 964-970.

Misumida, N., Ogunbayo, G. O., Kim, S. M., Abdel-Latif, A., Ziada, K. M., & Sorrell, V. L. (2019). Clinical outcome of Takotsubo cardiomyopathy diagnosed with or without coronary angiography. Angiology, 70(1), 56-61.

Nascimento, F. O., Yang, S., Larrauri-Reyes, M., Pineda, A. M., Cornielle, V., Santana, O., Heimowitz, T. B. et al. (2014). Usefulness of the troponin-ejection fraction product to differentiate stress cardiomyopathy from ST-segment elevation myocardial infarction. The American journal of cardiology, 113(3), 429-433.

Núñez Gil, I. J. N., Andrés, M., Delia, M. A., Sionis, A., Martín, A., Bastante, T., Soriano, J. G. C., Vicente, J. A. L. et al. (2015). Characterization of Tako-tsubo Cardiomyopathy in Spain: Results from the RETAKO National Registry. Revista Española de Cardiología. 68(6), 505-512.

Reis, J. G. V., & Rosas, G. (2010). Cardiomiopatia de Takotsubo: um diagnóstico diferencial da síndrome coronariana aguda: revisão da literatura. Rev Med Minas Gerais, 20(4), 594-600.

Samardhi, H., Raffel, O. C., Savage, M., Sirisena, T., Bett, N., Pincus, M., Small, A. et al. (2012). Takotsubo cardiomyopathy: an Australian single centre experience with medium term follow up. Internal medicine journal, 42(1), 35-42.

Santoro, F., Gil, I. J. N., Stiermaier, T., El-Battrawy, I., Guerra, F., Novo, G., Guastafierro, F. et al. (2019). Assessment of the German and Italian stress cardiomyopathy score for risk stratification for in-hospital complications in patients with Takotsubo syndrome. JAMA cardiology, 4(9), 892-899.

Santos, C. M. D. C., Pimenta, C. A. D. M., & Nobre, M. R. C. (2007). The PICO strategy for the research question construction and evidence search. Revista latino-americana de enfermagem, 15(3), 508-511.

Schwarz, K., Ahearn, T., Srinivasan, J., Neil, C. J., Scally, C., Rudd, A., Jagpal, B. et al. (2017). Alterations in cardiac deformation, timing of contraction and relaxation, and early myocardial fibrosis accompany the apparent recovery of acute stress-induced (takotsubo) cardiomyopathy: an end to the concept of transience. Journal of the American Society of Echocardiography, 30(8), 745-755.

Souza, M. T. D., Silva, M. D. D., & Carvalho, R. D. (2010). Integrative review: what is it? How to do it?. Einstein (São Paulo), 8(1), 102-106.

Stiermaier, T., Moeller, C., Oehler, K., Desch, S., Graf, T., Eitel, C., Vonthein, R. et al. (2016). Long‐term excess mortality in takotsubo cardiomyopathy: predictors, causes and clinical consequences. European journal of heart failure, 18(6), 650-656.

Takahashi, J., Saheki, Y., Gardim, S. (2014). O que é PICO e Pico?. SlideShare. https://pt.slideshare.net/bibliotecaee/o-que-pico-e-pico.

Templin, C., Ghadri, J. R., Diekmann, J., Napp, L. C., Bataiosu, D. R., Jaguszewski, M., Cammann, V. L. (2015). Clinical features and outcomes of Takotsubo (stress) cardiomyopathy. New England Journal of Medicine, 373(10), 929-938.

Vallabhajosyula, S., Barsness, G. W., Herrmann, J., Anavekar, N. S., Gulati, R., & Prasad, A. (2020). Comparison of Complications and In-Hospital Mortality in Takotsubo (Apical Ballooning/Stress) Cardiomyopathy Versus Acute Myocardial Infarction. The American Journal of Cardiology, 132, 29-35.

Vallabhajosyula, S., Dunlay, S. M., Murphree, D. H., Barsness, G. W., Sandhu, G. S., Lerman, A., & Prasad, A. (2019). Cardiogenic shock in takotsubo cardiomyopathy versus acute myocardial infarction: an 8-year national perspective on clinical characteristics, management, and outcomes. JACC: Heart Failure, 7(6), 469-476.

Vizzardi, E., Bonadei, I., Rovetta, R., Sciatti, E., D’Aloia, A., Pezzali, N., Salghetti, F. et al. (2015). Characteristics and mid-term follow-up of a single-center population affected by Tako-Tsubo cardiomyopathy. Journal of Cardiovascular Medicine, 16(5), 326-330.

Weihs, V., Szücs, D., Fellner, B., Eber, B., Weihs, W., Lambert, T., Metzler, B. et al. (2013). Stress-induced cardiomyopathy (Tako-Tsubo syndrome) in Austria. European Heart Journal: Acute Cardiovascular Care, 2(2), 137-146.

Yayehd, K., N’kenon, W., Belle, L., Bataille, V., Hanssen, M., Leddet, P., Aupetit, J. F. et al. (2016). Management of Takotsubo cardiomyopathy in non-academic hospitals in France: the Observational French SyndromEs of TakoTsubo (OFSETT) study. Archives of cardiovascular diseases, 109(1), 4-12.

Yerasi, C., Koifman, E., Weissman, G., Wang, Z., Torguson, R., Gai, J., Lindsay, J. et al. (2017). Impact of triggering event in outcomes of stress-induced (Takotsubo) cardiomyopathy. European Heart Journal: Acute Cardiovascular Care, 6(3), 280-286.

Published

18/01/2022

How to Cite

MENDES, I. P. G.; FONSECA NETO, O. J.; SANTANA, B. V. R. C. .; SOUZA, J. L. de; VIANA, B. L. A. .; CORREIA, R. S.; ARAUJO, H. J. B. .; KRÜGER, Y. da S. .; MENDES, Érica de A. S. .; MOITA, A. N. C. . Takotsubo cardiomyopathy as a differential diagnosis of acute coronary syndrome: differences between clinical features. Research, Society and Development, [S. l.], v. 11, n. 2, p. e8111225514, 2022. DOI: 10.33448/rsd-v11i2.25514. Disponível em: https://www.rsdjournal.org/index.php/rsd/article/view/25514. Acesso em: 2 mar. 2024.

Issue

Section

Review Article