Electrocardiographic findings of takotsubo cardiomyopathy as compared with those of anterior acute myocardial infarction

Takotsubo cardiomyopathy (TC) is a recently recognized novel cardiac syndrome characterized by transient left ventricular dysfunction without obstructive coronary disease, electrocardiographic (ECG) changes (ST-segment elevation and/or negative T wave) or elevated cardiac enzymes. Because the clinical features and ECG findings of TC mimic those of anterior acute myocardial infarction (AMI) with occlusion of the left anterior descending coronary artery, differential diagnosis has an important role in selecting the most appropriate treatment strategy. Especially in the acute phase, differential diagnosis is essential for deciding whether reperfusion therapy is required. Although it has been suggested that ECG does not allow reliable differentiation between TC and anterior AMI, several ECG criteria distinguishing TC from anterior AMI have been proposed. In this review, we discuss ECG findings of TC, especially in the acute phase, compare them with those of anterior AMI, and identify ECG features that may facilitate early recognition of this disease.