Glycoprotein IIb/IIIa antagonists in Takotsubo cardiomyopathy

Excerpt

Takotsubo cardiomyopathy (TC) is an under-recognized clinical entity mimicking acute coronary syndrome. Glycoprotein IIb/IIIa (GP IIb/IIIa) antagonists are not indicated in TC; however, in some instances, TC masquerades as ST-segment elevation myocardial infarction (STEMI) when chest pain, ST-segment elevation, and troponin leak coexist. ST-segment elevation is the commonest finding on the admission electrocardiogram (ECG) in patients with TC and is seen in 46–100% of patients [1]. Prior to confirming the diagnosis, these patients are usually managed with an initial working diagnosis of myocardial infarction with aspirin, beta blockers, intravenous heparin, GP IIb/IIIa antagonists, or even thrombolytic therapy. In developing countries, thrombolytic therapy is the mainstay of reperfusion for STEMI, either because it is cheaper or due to the lack of widespread availability of catheterization suites, and can be unnecessarily given in cases with suspected TC presenting with chest pain and ST-segment elevation. The diagnosis of TC is only confirmed when occlusive coronary artery disease is absent on coronary angiography and the characteristic apical ballooning is evident on left ventriculogram. This highlights the importance of recognizing the distinguishing ECG features that can—to a great extent—differentiate TC from STEMI. …