Namgung June
Division of Cardiology, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea.
Clin Med Insights Cardiol. 2014 Mar 13;8:29-34. doi: 10.4137/CMC.S14086. eCollection 2014.
Electrocardiogram (ECG) manifestations of takotsubo cardiomyopathy (TC) produce ST-segment elevation or T-wave inversion, mimicking acute coronary syndrome (ACS). We describe the ECG manifestation of TC, including ECG evolution, and its different points from ACS.
We studied 37 consecutive patients (age 67 ± 15 years, range 23-89, M:F = 12:25) from March 2004 to November 2012 with a diagnosis of TC who were proven to have apical ballooning on echocardiography or left ventricular angiography and normal coronary artery. We analyzed their standard 12-lead ECGs, including rate, PR interval, QRS duration, corrected QT (QTc) interval, ECG evolutions, and arrhythmia events.
Two common ECG findings in TC were ST-segment elevation (n = 13, 35%) and T inversion (n = 24, 65%), mostly in the precordial leads. After ST-segment resolution, in a few days (3.5 days), diffuse and often deep T-wave inversion developed. Eight patients (22%) had transient Q-waves lasting a few days in precordial leads. No reciprocal ST-segment depression was noted. T-wave inversion continued for several months. QT prolongation (<440 milliseconds) was observed in 37 patients (97%). There were no significant life-threatening arrhythmias except atrial fibrillation (n = 6, 16%).
There are distinct differences between the ECGs of TC and ACS. These differences will help to differentiate TC from ACS.
应激性心肌病（TC）的心电图（ECG）表现为ST段抬高或T波倒置，类似于急性冠状动脉综合征（ACS）。我们描述了TC的ECG表现，包括ECG演变及其与ACS的不同之处。
我们研究了2004年3月至2012年11月期间连续诊断为TC的37例患者（年龄67±15岁，范围23 - 89岁，男：女 = 12:25），这些患者经超声心动图或左心室血管造影证实有室壁瘤形成且冠状动脉正常。我们分析了他们的标准12导联ECG，包括心率、PR间期、QRS时限、校正QT（QTc）间期、ECG演变和心律失常事件。
TC常见的两种ECG表现为ST段抬高（n = 13，35%）和T波倒置（n = 24，65%），大多出现在胸前导联。ST段恢复后，在几天内（3.5天）出现弥漫性且常为深的T波倒置。8例患者（22%）胸前导联出现持续数天的短暂Q波。未观察到ST段的对应性压低。T波倒置持续数月。37例患者（97%）观察到QT延长（<440毫秒）。除房颤外（n = 6，16%），无严重危及生命的心律失常。
TC和ACS的ECG存在明显差异。这些差异有助于将TC与ACS区分开来。
