Takotsubo Cardiomyopathy ECG Review

The ECG findings in Takotsubo cardiomyopathy ― also known as stress-induced cardiomyopathy, broken-heart syndrome or apical-ballooning syndrome ― are nonspecific, meaning there is not one typical ECG appearance to diagnose this disease.

Potential ECG findings include the following:

• ST segment elevation
• ST segment depression
• Left bundle branch block
• Prolonged QT interval

While Takotsubo cardiomyopathy can occur in the setting of a normal ECG, the findings most commonly mimic ischemia in the anterior distribution. Below is an ECG from a patient with Takotsubo Cardiomyopathy:

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Here is another Takotsubo ECG ― this one showing a typical LBBB pattern.

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ECG Examples:

Left Bundle Branch Blocks

• Left Bundle Branch Block (LBBB) ECG (Example 1)
• Left Bundle Branch Block (LBBB) ECG (Example 2)
• Left Bundle Branch Block (LBBB) ECG (Example 3)
• Left Bundle Branch Block (LBBB) ECG (Example 4)
• Left Bundle Branch Block (LBBB) ECG (Example 5)
• Left Bundle Branch Block (LBBB) ECG (Example 6)

Anterior Wall Myocardial Infarctions

• Anterior Wall ST Segment Elevation Myocardial Infarction (MI) ECG (Example 1)
• Anterior Wall ST Segment Elevation Myocardial Infarction (MI) ECG (Example 2)
• Anterior Wall ST Segment Elevation Myocardial Infarction (MI) ECG (Example 3)
• Anterior Wall ST Segment Elevation Myocardial Infarction (MI) ECG (Example 4)
• Anterior Wall ST Segment Elevation Myocardial Infarction (MI) ECG (Example 5)
• Anterior Wall ST Segment Elevation Myocardial Infarction (MI) ECG (Example 6)
• Anterior Wall ST Segment Elevation Myocardial Infarction (MI) with RBBB ECG (Example 1)
• Anterior Wall ST Segment Elevation Myocardial Infarction (MI) with RBBB ECG (Example 2)

References:
1. Chou’s Electrocardiography in Clinical Practice: Adult and Pediatric, 6e
2. Surawicz B, et al. AHA/ACCF/HRS Recommendations for the Standardization and Interpretation of the Electrocardiogram. Circulation. 2009; doi:10.1161/CIRCULATIONAHA.108.191095.