Which diagnostic tests are most effective in confirming a diagnosis of Takotsubo cardiomyopathy in a primary care setting?

The provided UK guidelines do not specify diagnostic tests for confirming a diagnosis of Takotsubo cardiomyopathy in a primary care setting.

However, for individuals presenting with recent-onset chest pain of suspected cardiac origin, primary care assessment would typically involve taking a careful and detailed history, performing a clinical examination, and obtaining a resting 12-lead ECG ¹. Changes on a resting 12-lead ECG, such as pathological Q waves, left bundle branch block (LBBB), or ST-segment and T-wave abnormalities, may indicate ischaemia or previous infarction ¹.

If an acute coronary syndrome (ACS) is suspected, patients are usually referred to hospital where a resting 12-lead ECG and a blood sample for high-sensitivity troponin I or T measurement are taken on arrival ¹. A raised troponin level, detected in people with a suspected ACS, requires reassessment to exclude other causes (for example, myocarditis, aortic dissection, or pulmonary embolism) before confirming the diagnosis of ACS ¹. Takotsubo cardiomyopathy would fall under these 'other causes' that are typically differentiated in a secondary care setting.

For suspected heart failure, N-terminal pro-B-type natriuretic peptide (NT-proBNP) is measured, and depending on the level, urgent or specialist assessment and transthoracic echocardiography within 2 to 6 weeks are recommended ².