7th March 2024

Investigations

The diagnosis of Takotsubo’s cardiomyopathy is commonly suspected due to a typical history of a stressful emotional or physical event with ischaemic sounding chest pain. It is a diagnosis of exclusion, and an acute coronary syndrome should be excluded in the first instance through invasive coronary angiography. If there are no clear culprit lesions for the disease on angiography, then Takotsubo can be considered.

Classical Takotsubo’s can be suspected by typical echocardiographic findings of left ventricular mid cavity and apical ballooning with relative preservation of basal ventricular function. In general, if there are regional wall motion abnormalities that do not fit a particular coronary pattern, then takotsubo should be considered. There are non-classical versions of Takotsubo’s cardiomyopathy in which apical and mid-cavity ballooning are not the echocardiographic findings but these are less common.

ECG will typically show ST segment change or T wave inversion, similar to that of an acute coronary syndrome, though it may not be consistent with a particular coronary territory and is more likely to be global.

Bloods – Troponin and BNP will typically be elevated, which normally leads to suspicion of an acute coronary syndrome in the acute setting.

As a diagnosis of exclusion, it also must be ensured that there is no concomitant myocarditis, head trauma or phaeochromocytoma to cause a similar but pathophysiologically distinct syndrome.