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. Author manuscript; available in PMC: 2022 Apr 1.
Published in final edited form as: Circulation. 2022 Mar 28;145(13):1002–1019. doi: 10.1161/CIRCULATIONAHA.121.055854

Table 1. Differential Diagnosis in Takotsubo Syndrome.

Takotsubo syndrome Myocardial Infarction with Non-obstructive Coronary Arteries Type 2 Myocardial Infarction Type 1 Myocardial Infarction
Characteristic Clinical Features

  • Acute chest pain or dyspnea

  • Preceding stressor*

  • Can be associated in the context of other illness

  • Pre-existing psychiatric illness

  • Acute chest pain

  • Varies depending on underlying pathology

  • Requires clinical evidence of myocardial infarction

  • Acute chest pain

  • Supply or demand imbalance

  • Tachycardia or hypotension

  • Concomitant illness

  • Usually have co-morbidities

  • Acute chest pain

  • Traditional cardiovascular risk factors
Investigations Electrocardiogram

  • Widespread ST-segment or T wave abnormality

  • QTc prolongation (late)

  • New Ischaemic changes

  • New ischaemic changes

  • Tachycardia

  • Territorial ST-segment or T wave abnormality
Bloods

  • Moderate cardiac troponin elevation

  • Marked BNP and CRP elevation

  • Elevated troponin >99th centile

  • Elevated troponin >99th centile

  • Marked cardiac troponin elevation

  • Moderate BNP and CRP elevation
Echocardiography

  • Temporary left ventricular dysfunction regional wall motion abnormality depending on subtype of takotsubo (apical, basal, focal)

  • Normal or persistent left ventricular impairment

  • regional wall motion abnormality

  • Normal or persistent left ventricular impairment

  • May have regional wall motion abnormality

  • Normal or persistent left ventricular impairment

  • regional wall motion abnormality
Coronary Angiography

  • Normal or non-obstructive coronary artery disease

  • Apical ballooning on left ventriculogram

  • Normal or nonobstructive coronary artery disease

  • Evidence of acute plaque rupture on intra-vascular ultrasound or optical coherence tomography

  • Normal, nonobstructive or obstructive coronary artery disease

  • Obstructive disease
Magnetic Resonance Imaging

  • No persistent late gadolinium enhancement

  • Elevated Native T1/T2

  • Late gadolinium enhancement

  • regional wall motion abnormality

  • Normal or late gadolinium enhancement

  • May have regional wall motion abnormality

  • Late gadolinium enhancement-infarct pattern

  • Elevated native T1/T2

  • regional wall motion abnormality

BNP, B-type natriuretic peptide, CRP, C-reactive protein

*

Not always