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Takotsubo cardiomyopathy (TC) often masquerades as an acute coronary syndrome (ACS) with ECG changes, elevated troponins and/or chest discomfort. Its exact incidence in ACS is unknown but most studies suggest a rate of 1–2%. As most patients with TC are postmenopausal women (PMW), it was hypothesized that the incidence would be higher in this population.
A prospective evaluation was carried out in all PMWs (women >45 years of age) with an elevated troponin presenting to a large Community Hospital over a 1 year period (July 20, 2011 to July 19, 2012). Troponin results above the upper limit of normal (0.04 ng/mL) were screened on a daily basis through a computerized system. The patient's in-hospital charts were reviewed by 2 cardiologists and determined if they fulfilled the criteria for acute myocardial infarction (AMI) based on the Universal Definition of myocardial infarction. Pre-specified criteria (clinical and imaging data) were utilized to identify all patients with probable or definite TC.
Among the 1297 PMWs screened for positive troponins, 323 patients (24.9%) fulfilled the criteria for acute myocardial infarction and of these, 22 (6.8%) met the criteria for TC. Only 3 patients with TC had acute neurologic events. There was a seasonal predilection during the summer months (40.9%) and the majority of patients (81.8%) had the apical variant of TC.
Takotsubo cardiomyopathy may be more common than reported in postmenopausal women with clinical and laboratory criteria suggesting AMI. Heightened awareness of TC in this population appears warranted.
Poster Sessions, Expo North
Saturday, March 09, 2013, 10:00 a.m.-10:45 a.m.
Session Title: Stress, Coronary Spasm and AMI: Lessons from Japan, New Orleans, Greece
Abstract Category: 1. Acute Coronary Syndromes: Clinical
Presentation Number: 1130-212
- 2013 American College of Cardiology Foundation