Typical dynamic electrocardiographic changes in Takotsubo syndrome

Negative T waves and QTc prolongation often occur in patients with Takotsubo syndrome. Description of typical electrocardiographic changes could be a diagnosis element of this syndrome. This study aimed to clarify on the one hand the more preciously possible the typical electrocardiographic changes, and on the other hand, the timing of occurrence of these abnormalities compared to the trigger occurrence, the symptoms onset and the hospital admission.

We studied ECGs at admission of 59 patients with Takotsubo syndrome, a 'reference' ECG and each one available during the first five days after admission.We observed significant changes on the pathological ECG compared to reference ECG: the mean number of leads with negative T waves (7.4 ± 1.9 mm vs 2.1 ± 1.4 mm, p < 0.0001), the highest value of negative T wave deflection among all the leads (-6.2 ± 4mm vs -1.4 ± 0.9 mm, p < 0.0001), the sum of all negative T waves (-27 ± 1.7 mm vs -2.8 ± 3.6 mm, p < 0.0001 and a QTc max and QTc mean prolongation (539 ± 63ms vs 457 ± 42ms, p < 0.0001 and 491 ± 52ms vs 421 ± 33ms, p < 0.0001 respectively). We also demonstrated that T waves were significantly more positive in pathological ECG in aVR and V1 compared to the reference one (mean value of T waves respectively of 1.8 ± 1.8 vs -1 ± 1.3, p < 0.0001 and 0.7 ± 1.6 vs 0.004 ± 1.2, p = 0.008).

The QTc prolongation, the profound negative T waves except in aVR and V1 occurring the first two days after admission are electrocardiographic changes typically of Takotsubo syndrome.