- HPI: 50 something with abominal pain, no chest pain
- Key ECG: Bizarre T-waves, with T-wave inversion and extremely long QT. The computer measures the QT at 506 ms, but it really is more like 560-580 ms, with a QTc of 600-620 ms. This is not at all typical of ACS but very typical of takotsubo or stress cardiomyopathy. Takotsubo may manifest T-wave inversion, but also STE that mimics STEMI. Although earlier work had suggested that ECG criteria might distinguish this STE from anterior STEMI,(57) recent literature does not support this result.(58 59) Many anterior STEMI, especially due to wraparound LAD to the inferior wall, have similar ECG findings and also apical ballooning. Therefore, coronary angiography is often essential to rule out acute coronary occlusion, even when the STE pattern and cardiac ultrasound both suggest Takotsubo.
- Source: Dr. Smith’s ECG Blog: 2020-03-25