Takotsubo syndrome: Advances in the understanding and management of an enigmatic stress cardiomyopathy

Table 4 Electrocardiographic findings in takotsubo cardiomyopathy

T waves inversion	ST-segment	QRS complex	Q waves
Are the most frequent finding along ECG evolution	Makes priority rule out obstructive coronary artery disease	aVR lead is especially sensible to changes in voltage because it "faces" the apex	Permanent pathological Q waves are exceptional
Appear mainly in precordial leads (V2-V6)	More frequent on precordial leads, except V1
Negative T waves are deep, symmetrical and widespread	Reciprocal depression is less frequent than in STEMI
Progressive QT-interval prolongation	Suspicious combinations:
	ST-depression in aVR plus no elevation in V1 (91% sensitivity, 96% specificity)[87]
	The sum of elevation in V4-V6/V1-V3 ≥ 1 (77% sensitivity, 80% specificity)[65]
No negative T wave in V1 plus positive T wave in aVR must raise suspicion (95% sensitivity, 97% specificity)[62]	Level of ST segment elevation lesser than in anterior STEMI

ECG: Electrocardiogram; STEMI: ST-segment elevation myocardial infarction.