Table 5.
DIAGNOSTIC CRITERIA FOR TAKOTSUBO SYNDROME.
| Modified Mayo Clinic Criteria36 | European Heart Failure Association Diagnostic Criteria1 |
|---|---|
| 1. Transient hypokinesia or akinesia of LV with regional wall motion abnormality, majority involving apex & mid LV (or other areas) extending beyond the distribution of single epicardial artery; hypokinesia invariably (but not always) follows stressful trigger which could be emotional or physical. | 1. Transient regional wall motion abnormalities of LV (or RV) myocardium which are frequently but not always preceded by stressful trigger (emotional or physical). |
| 2. Appearance of new ECG abnormalities like ST elevation, T inversion, Q waves with mild elevation of troponins and pro-BNP markers | 2. The regional wall motion abnormality usually (exceptions reported) extends beyond a single epicardial vascular distribution and often results in circumferential dysfunction of the ventricular segment involved. |
| 3. Absence of obstructive lesion (plaque rupture, thrombus or spasm) of epicardial coronary artery (thus excluding STEMI, NSTEMI and prinzmetal angina) | 3. New and reversible ECG abnormalities (ST segment elevation, ST depression, LBBB, T wave inversion and/or QTc prolongation in acute phase |
| 4. Absence of phaeochromocytoma and myocarditis | 4. Significant elevation of serum natriuretic peptide (BNP or NT-proBNP) during acute phase. |
| 5. Positive but relatively small elevation of cardiac troponin measured with a conventional assay (troponin −ve cases have been reported). | |
| 6. Absence of culprit atherosclerotic disease including plaque rupture, thrombus formation and coronary dissection or other pathological conditions to explain the pattern of temporary LV Dysfunction e.g. hypertrophic cardiomyopathy, viral myocarditis etc. | |
| 7. Recovery of ventricular function on cardiac imaging on follow up (3–6 months). |
(ECG-electrocardiogram, LV-left ventricle, BNP-brain natriuretic peptide, STEMI-ST elevation myocardial infarction, NSTEMI-NonST elevation myocardial infarction, RV-right ventricle, LBBB-left bundle branch block).