Takotsubo syndrome in African-American women with atypical presentations: A single-center experience

Background: Takotsubo syndrome is comprised of the clinical presentation of an acute myocardial infarction with electrocardiographic (ECG) changes of acute ischemia, chest pain, positive biomarkers, a pathognomonic left ventricular apical wall motion abnormality, and no culprit coronary disease at cardiac catheterization. Hapothesis: This study aimed at a further definition of the clinical characteristics of this syndrome in African-American (AA) patients based on our experience at a single center. Methods: Patients who presented with this syndrome between June 2003 and June 2005 were evaluated. All patients underwent coronary angiography and noninvasive cardiac investigation, including transthoracic two-dimensional echocardiography. Results: Five AA women (mean age 65 years) presented with the characteristics of the syndrome. No patient experienced chest pain, with three presenting with shortness of breath and two with nausea. Hypertension was the most common risk factor for coronary artery disease (CAD) in these patients. All but one patient had ST elevation on ECG, and troponin I elevation was present in all. Cardiac catheterization showed no obstructive CAD. The most common trigger was exarcebation of a current medical condition. All five patients developed deep, broad, diffuse T-wave inversions with a prolonged QT interval. There was no mortality during the hospital stay. Conclusions: Takotsubo syndrome is experienced by AA patients. Female AA patients may experience atypical symptoms at presentation. The development of broad, diffuse, T-wave inversions with a prolonged QT interval within 2-48 h of presentation should be considered an additional criterion when diagnosing Takotsubo syndrome.