Takotsubo cardiomyopathy (diagnostic criteria)
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Takotsubo cardiomyopathy, alternatively Takotsubo syndrome, is a primary acquired cardiomyopathy characterized by transient left ventricular dysfunction. Several sets of diagnostic criteria exist and are variably utile in various clinical and research settings.
International Takotsubo Diagnostic Criteria (2018)
- evidence of transient left ventricular dysfunction with abnormal wall motion in an apical, focal, midventricular, or basal distribution 2
- classic description as apical "ballooning" or dyskinesis
- typically involves more than one discrete coronary artery territory
- involvement of the right ventricle may also occur
- a preceding trigger, which may be physical and/or emotional, may be present but is not required
- triggers may also include neurologic conditions or a pheochromocytoma
- subarachnoid hemorrhage, status epilepticus, and ischemic stroke are potential culprits
- usually associated with new electrocardiographic abnormalities, may rarely be absent
- these include ST segment deviation, T wave inversion, and prolongation of the corrected QT interval
- moderate elevation of cardiac biomarkers such as creatine kinase and troponin common
- marked elevation of brain
natiureticnatriuretic peptide concentrations also common
- marked elevation of brain
- may exist concomitantly with significant coronary artery disease
- absence of factors suggestive of infectious myocarditis
- may be evaluated with cardiac magnetic resonance imaging (MRI)
- predilection to affect postmenopausal females
Revised Mayo Clinic diagnostic criteria (2008)
- transient wall motion abnormalities involving the left ventricular mid segments with or without apical involvement, involved territory extends beyond a discrete epicardial coronary artery vascular distribution, and a stressful trigger is typically (but not obligatorily) present 1
- absence of acute plaque rupture demonstrated on coronary angiography
,and absence of obstructive coronary artery disease - new ST segment elevation and/or T wave inversion demonstrated on an electrocardiogram
,or a modest rise in troponin levels - no evidence of myocarditis or a pheochromocytoma
-<p><strong>Takotsubo cardiomyopathy</strong>, alternatively Takotsubo syndrome, is a primary acquired <a title="Cardiomyopathy (WHO/ISFC 1995 classification)" href="/articles/cardiomyopathy-whoisfc-1995-classification">cardiomyopathy</a> characterized by transient left ventricular dysfunction. Several sets of diagnostic criteria exist and are variably utile in various clinical and research settings.</p><h4>International Takotsubo Diagnostic Criteria (2018)</h4><ul>-<li>evidence of transient left ventricular dysfunction with abnormal <a title="Cardiac wall motion abnormalities" href="/articles/cardiac-wall-motion-abnormalities">wall motion</a> in an apical, focal, midventricular, or basal distribution <sup>2</sup><ul>- +<p><strong>Takotsubo cardiomyopathy</strong>, alternatively Takotsubo syndrome, is a primary acquired <a href="/articles/cardiomyopathy-whoisfc-1995-classification">cardiomyopathy</a> characterized by transient left ventricular dysfunction. Several sets of diagnostic criteria exist and are variably utile in various clinical and research settings.</p><h4>International Takotsubo Diagnostic Criteria (2018)</h4><ul>
- +<li>evidence of transient left ventricular dysfunction with abnormal <a href="/articles/cardiac-wall-motion-abnormalities">wall motion</a> in an apical, focal, midventricular, or basal distribution <sup>2</sup><ul>
-<li>typically involves more than one discrete <a title="Coronary artery" href="/articles/coronary-arteries">coronary artery</a> territory</li>- +<li>typically involves more than one discrete <a href="/articles/coronary-arteries">coronary artery</a> territory</li>
-<a title="Subarachnoid hemorrhage" href="/articles/subarachnoid-haemorrhage">subarachnoid hemorrhage</a>, status epilepticus, and ischemic stroke are potential culprits</li></ul>- +<a href="/articles/subarachnoid-haemorrhage">subarachnoid hemorrhage</a>, status epilepticus, and ischemic stroke are potential culprits</li></ul>
-<li>moderate elevation of cardiac biomarkers such as creatine kinase and troponin common<ul><li>marked elevation of brain natiuretic peptide concentrations also common</li></ul>- +<li>moderate elevation of cardiac biomarkers such as creatine kinase and troponin common<ul><li>marked elevation of brain natriuretic peptide concentrations also common</li></ul>
-<li>absence of factors suggestive of infectious <a title="Myocarditis" href="/articles/myocarditis">myocarditis</a><ul><li>may be evaluated with <a title="Myocarditis protocol (MRI)" href="/articles/myocarditis-protocol-mri">cardiac magnetic resonance imaging</a> (MRI)</li></ul>- +<li>absence of factors suggestive of infectious <a href="/articles/myocarditis">myocarditis</a><ul><li>may be evaluated with <a href="/articles/myocarditis-protocol-mri">cardiac magnetic resonance imaging</a> (MRI)</li></ul>
-<li>transient wall motion abnormalities involving the left ventricular mid <a title="Left ventricular anatomy" href="/articles/left-ventricle">segments</a> with or without apical involvement, involved territory extends beyond a discrete epicardial coronary artery vascular distribution, and a stressful trigger is typically (but not obligatorily) present <sup>1</sup>- +<li>transient wall motion abnormalities involving the left ventricular mid <a href="/articles/left-ventricle">segments</a> with or without apical involvement, involved territory extends beyond a discrete epicardial coronary artery vascular distribution, and a stressful trigger is typically (but not obligatorily) present <sup>1</sup>
-<li>absence of acute plaque rupture demonstrated on coronary angiography, and absence of obstructive coronary artery disease</li>-<li>new ST segment elevation and/or T wave inversion demonstrated on an electrocardiogram, or a modest rise in <a title="Troponin" href="/articles/troponin">troponin</a> levels</li>- +<li>absence of acute plaque rupture demonstrated on coronary angiography and absence of obstructive coronary artery disease</li>
- +<li>new ST segment elevation and/or T wave inversion demonstrated on an electrocardiogram or a modest rise in <a href="/articles/troponin">troponin</a> levels</li>