Author + information
- Andrés Carrillo, MD, PhD,
- Miquel Fiol, MD, PhD,
- Javier García-Niebla, RN⁎ ( and )
- Antonio Bayés de Luna, MD, PhD
- ↵⁎Valle Del Golfo Health Center C/ Marcos Luis Barrera 1, 38911 Frontera-El Hierro, Islas Canarias, Spain
Kosuge et al. (1) present an interesting analysis on differentiating Takotsubo cardiomyopathy from anterior acute myocardial infarction using electrocardiographic criteria. However, we would like to draw attention to certain aspects of this paper. The authors do not report how the Takotsubo diagnosis was established; coronariography was not performed in 24% of the patients. In this regard, the presence of a normal coronary tree (2) does not confirm the diagnosis, because there are other causes of left ventricular apical ballooning (3).
A group of patients with anterior acute myocardial infarction was used for comparison without taking into account the site of occlusion of the left anterior descending (LAD) artery, which is of paramount importance for the interpretation of electrocardiographic results. The relationship of ST-segment elevation in V1-V2to V4-V6with the morphology of the ST segment in II, III, and aVF allows determining whether the occlusion is proximal or distal to the first diagonal branch (D1) (4,5). If it is proximal, the anterior muscle mass affected is large, and the lesion dipole is directed forward and upward; that explains the mirror image of ST-segment decrease in II, III, and aVF. Conversely, if the occlusion is distal to D1, the lesion dipole is directed anteriorly and slightly downward, generally resulting in an isoelectric or ascending ST-segment in II, III, and aVF. The example of a Takotsubo electrocardiogram pattern in Figure 1B by Kosuge et al. (1) is also typical of ST-segment elevation myocardial infarction due to occlusion that is distal to D1 (6).
We believe that the ST-segment shift in leads aVR and V1can help to differentiate Takotsubo syndrome from anterior acute myocardial infarction due to LAD occlusion that is proximal to D1, but not distal, in patients admitted within 6 h of the onset of symptoms.
- American College of Cardiology Foundation
- Kosuge M.,
- Toshiaki E.,
- Kiyoshi H.,
- et al.
- Engelen D.J.,
- Gorgels A.P.,
- Cheriex E.C.,
- et al.
- Bayés de Luna A.,
- Fiol-Sala M.