Takotsubo (Stress) Cardiomyopathy (Broken Heart Syndrome) Differential Diagnoses

Updated: Jul 31, 2019
  • Author: Eric B Tomich, DO; Chief Editor: Erik D Schraga, MD  more...
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Diagnostic Considerations

Physicians should be aware of the presentation of takotsubo (stress) cardiomyopathy (broken heart syndrome), 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 takotsubo cardiomyopathy 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 healthcare providers should be aware that the incidence of takotsubo cardiomyopathy might increase soon afterward. These patients should be treated in the ED as having acute coronary syndrome (ACS), be provided supportive treatment, and undergo subsequent cardiology evaluation. [32]

Takotsubo cardiomyopathy 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). [19]

Atypical forms of takotsubo cardiomyopathy 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. [26]

Conditions to consider in the differential diagnosis of takotsubo cardiomyopathy include the following:

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

Differential Diagnoses