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Takotsubo Syndrome Diagnosis — EECC MCQ

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EasyCardiomyopathyTakotsubo Syndrome DiagnosisEECC

A 35-year-old man presents with acute chest pain mimicking MI. Troponin is elevated. Coronary angiography is normal. CMR shows circumferential oedema and global hypokinesis with an apical ballooning pattern. Catecholamines are markedly elevated. He reports a recent bereavement. What is the diagnosis?

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Correct answer: A — Takotsubo syndrome (stress cardiomyopathy) — characterised by transient LV wall motion abnormalities triggered by emotional or physical stress, elevated catecholamines, and typical apical ballooning pattern; prognosis is generally good with LV recovery in 4-8 weeks

Takotsubo syndrome (TTS) accounts for 1-3% of troponin-positive acute presentations. The InterTAK diagnostic criteria: (1) transient LV wall motion abnormalities (apical ballooning most common; midventricular, basal/reverse, and focal variants exist); (2) emotional or physical trigger (bereavement, surgery, acute illness — present in ~70%); (3) new ECG changes (ST elevation, T-wave inversion, QT prolongation); (4) elevated biomarkers (troponin/NT-proBNP); (5) absence of culprit CAD (normal coronaries or non-culprit disease); (6) absence of myocarditis or phaeochromocytoma. CMR: diffuse oedema (T2) WITHOUT significant LGE (distinguishes from MI and myocarditis). Mechanism: catecholamine surge → direct myocardial toxicity and microvascular spasm. Recovery: LVEF normalises in 4-8 weeks in ~95%. Acute complications: cardiogenic shock (5-10%), LVOT obstruction, thrombus, arrhythmias. The ESC 2023 Cardiomyopathy Guidelines provide diagnostic criteria and recommend supportive care with GDMT consideration.

Reference: ESC (2023): Cardiomyopathies; InterTAK Criteria