Takotsubo Cardiomyopathy Differential Diagnoses

Updated: Jan 17, 2017
  • Author: Eric B Tomich, DO; Chief Editor: Erik D Schraga, MD  more...
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DDx

Diagnostic Considerations

Physicians should be aware of the presentation of takotsubo cardiomyopathy (TCM), because chest pain after a recent stressor is not necessarily due to anxiety. The chest pain may be more complicated and may deteriorate into dysrhythmias, shock, or both. 

Patients with TCM do not usually have cardiac risk factors, but their pain should be taken seriously. Also, patients may present to the emergency department (ED) after a natural disaster, and providers should be aware that the incidence of TCM might increase soon afterward. These patients should be treated in the ED as having acute coronary syndrome (ACS), be given supportive treatment, and undergo subsequent cardiology evaluation. [28]

TCM should also be a consideration in young patients who present with symptoms similar to those of coronary heart disease to avoid potentially unnecessary invasive interventions (eg, coronary artery stent placement). [16]

Atypical forms of TCM have been described with varying wall-motion abnormalities, including right ventricular and basal/midventricular akinesia. Clinically, these patients tend to present similarly to the classic form. [22]

Conditions to consider in the differential diagnosis of TCM include the following:

  • Esophageal spasm
  • Gastroesophageal reflux disease (GERD)
  • Myocardial infarction (MI)
  • Myocardial ischemia
  • Myocarditis
  • Acute pericarditis
  • Pneumothorax
  • Cardiogenic pulmonary edema
  • Pulmonary embolism (PE)
  • Unstable angina

Differential Diagnoses