Takotsubo - The great pretender.

Area of Science:

• Cardiology
• Internal Medicine

Background:

• Takotsubo syndrome, also known as stress cardiomyopathy, presents with symptoms mimicking acute myocardial infarction.
• Prior to its formal naming in 1990, the condition was frequently misdiagnosed.

Purpose of the Study:

• To identify and describe cardiac conditions that were historically misdiagnosed as or confused with takotsubo syndrome.
• To highlight the diagnostic challenges and evolving understanding of takotsubo syndrome.

Main Methods:

• A review of modern medical literature (circa 1970-present) was conducted.
• The review focused on identifying cases with clinical, echocardiographic, and angiographic features consistent with takotsubo syndrome.

Main Results:

• Nine conditions were identified that share features with takotsubo syndrome.
• Six previously reported conditions include STEMI, NSTEMI, MINOCA, cerebral T-waves, sepsis-related LV dysfunction, and stress-related cardiomyopathy.
• Three newly described conditions include presentations following IV thrombolytic therapy with normal coronaries, myocarditis mimicking MI, and myocardial stunning.

Conclusions:

• Takotsubo syndrome has a history of being misdiagnosed due to its resemblance to other cardiac conditions.
• Some mimickers are well-established, while others are newly described, underscoring the complexity of cardiac diagnosis.
• Future diagnostic advancements may reveal currently unrecognized conditions presenting similarly to takotsubo syndrome.