Frequency of Takotsubo Cardiomyopathy in Postmenopausal Women Presenting With an Acute Coronary Syndrome

Takotsubo cardiomyopathy (TC) may be more common than previously reported in postmenopausal women (PMW) presenting with acute coronary syndrome (ACS). TC often masquerades as an ACS with electrocardiographic changes, elevated troponins, and/or chest discomfort. Its exact incidence in ACS is unknown but most studies suggest it is 1% to 2.2%. As most patients with TC are PMW, it was hypothesized that the incidence would be greater in this population. A prospective evaluation was carried out in all middle-aged and older women (≥45 years of age) presumed to be peri- or postmenopausal with an elevated troponin presenting to a community hospital over a 1-year period (July 2011 to July 2012). Troponin results above the upper limit of normal were screened on a daily basis through a computerized system. The patients' in-hospital charts were reviewed and determined if they fulfilled the criteria for acute myocardial infarction according to the universal definition of myocardial infarction. Prespecified criteria were used to identify all patients with TC. Of the 1,297 PMW screened for positive troponins, 323 patients (24.9%) fulfilled the criteria for acute myocardial infarction and of these, 19 (5.9%) met the prespecified criteria for TC. Three additional patients with TC had acute neurologic events. Most patients (81.8%) had the apical variant. In conclusion, TC may be more common than reported in PMW with clinical and laboratory criteria suggesting acute myocardial infarction. Heightened awareness of TC in this population appears warranted.