|Heart Failure Association–European Society of Cardiology Criteria|
|International Takotsubo Diagnostic Criteria (InterTAK Diagnostic Criteria)|
|Revised Mayo Clinic Criteria|
BNP = B-type natriuretic peptide; LBBB = left bundle branch block; LV = left ventricular; NT-BNP = N-terminal pro–B-type natriuretic peptide.
↵∗ Acute, reversible dysfunction of a single coronary territory has been reported.
↵† Left bundle branch block may be permanent after Takotsubo syndrome, but should also alert clinicians to exclude other cardiomyopathies. T-wave changes and QTc prolongation may take many weeks to months to normalize after recovery of LV function.
↵‡ Troponin-negative cases have been reported, but are atypical.
↵§ Small apical infarcts have been reported. Bystander subendocardial infarcts have been reported, involving a small proportion of the acutely dysfunctional myocardium. These infarcts are insufficient to explain the acute regional wall motion abnormality observed.
↵‖ Wall motion abnormalities may remain for a prolonged period of time or documentation of recovery may not be possible. For example, death before evidence of recovery is captured.
↵¶ Cardiac magnetic resonance imaging is recommended to exclude infectious myocarditis and diagnosis confirmation of Takotsubo syndrome.
↵# There are rare exceptions to these criteria, such as those patients in whom the regional wall motion abnormality is limited to a single coronary territory.
↵∗∗ It is possible that a patient with obstructive coronary atherosclerosis may also develop stress cardiomyopathy. However, this is very rare in our experience and in the published data, perhaps because such cases are misdiagnosed as an acute coronary syndrome. In both of the above circumstances, the diagnosis of stress cardiomyopathy should be made with caution, and a clear stressful precipitating trigger must be sought.