Author + information
- R. Todd Hurst, MD⁎ (, )
- Abhiram Prasad, MD,
- J. Wells Askew III, MD,
- Partho P. Sengupta, MBBS and
- A. Jamil Tajik, MD
- ↵⁎Mayo Clinic, Cardiovascular Diseases, 13400 E. Shea Boulevard, Scottsdale, Arizona 85259
We would like to thank Dr. Movahed for his interest in our paper (1), and welcome the opportunity to respond to his comments.
We agree that echocardiography is a valuable tool in the evaluation of patients who present with signs and symptoms suggestive of an acute coronary syndrome, a situation in which takotsubo cardiomyopathy is an important differential diagnosis. We also agree that there are several clinical and echocardiographic characteristics that are highly suggestive of the diagnosis of takotsubo cardiomyopathy. There are specific situations where the presentation is compelling enough that coronary angiography may be reasonably deferred in the presence of significant comorbidities that would increase the risk of cardiac catheterization. However, the pattern of regional wall motion abnormality of the left ventricle in many patients with an acute coronary syndrome, especially when due to ischemia in the left anterior descending coronary artery territory, can mimic takotsubo cardiomyopathy. Moreover, in occasional patients with takotsubo cardiomyopathy, the pattern of regional wall motion abnormality may not involve multiple coronary distributions. Thus, given the typically low risk of performing coronary angiography in most patients and the potential adverse consequences of an incorrect diagnosis with respect to an acute coronary syndrome, we advocate that urgent or emergent coronary angiography be performed in the absence of absolute contraindications, to exclude occlusive coronary artery disease. Indeed, takotsubo cardiomyopathy can, in rare circumstances, coexist with occlusive coronary artery disease, as highlighted in the modified Mayo Clinic diagnostic criteria (2). Ultimately, clinical judgment is required to differentiate takotsubo cardiomyopathy from other etiologies of acute coronary syndrome.
- American College of Cardiology Foundation