Stress cardiomyopathy differential diagnosis
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Dima Nimri, M.D. [2] Arzu Kalayci, M.D. [3]
Overview
Overview
The clinical presentation, laboratory findings and imaging studies of stress cardiomyopathy resembles that of anterior MI and must be differentiated from it. Also, stress cardiomyopathy must be differentiated from Takotsubo-like cardiomyopathy, such as that due to pheochromocytoma.
Differentiating Stress Cardiomyopathy from other Diseases
Differentiating Stress Cardiomyopathy from other Diseases
The presentation of stress cardiomyopathy mimics that of anterior wall MI and must be differentiated from it. There are some studies in the literature comparing left ventricular functions between acute myocardial infarction and stress cardiomyopathy. Although, systolic functions of the left ventricle were more impaired in stress cardiomyopathy group compared with acute myocardial infarction group, diastolic functions were better in these patients. [1] [2]
| Disease | Can Present With | Cardiac Enzymes | Catecholamine Levels | ECG Findings | Echocardiography Findings |
|---|---|---|---|---|---|
| Stress Cardiomyopathy | Chest pain, dyspnea | ↑ | Transiently elevated | ST elevation in precordial leads | LV regional dysfunction |
| Pheochromocytoma | Chest pain, dyspnea | Can be positive | Persistently elevated | ST elevation in precordial leads | LV regional dysfunction |
| Anterior MI | Chest pain, dyspnea | ↑↑↑ | – | ST elevation in precordial leads | Dysfunction at area of infarction |
| Myocarditis | Chest pain, dyspnea, fever | May be acutely elevated | – | May show atrial fibrillation, LBBB or AV block | Diffuse hypokinesia |
| Dilated Cardiomyopathy | Dyspnea, dyspnea on exertion, cough, edema, fatigue | Usually negative | – | May show atrial fibrillation, LBBB or AV block | LV enlargement |
| Hypertrophic Cardiomyopathy | Chest pain, dyspnea, syncope, sudden cardiac death | Usually negative | – | Common findings include: | LV hypertrophy, systolic anterior motion of the mitral valve, asymmetric septal hypertrophy |
References
References
- ↑ Medeiros K, O’Connor MJ, Baicu CF, Fitzgibbons TP, Shaw P, Tighe DA; et al. (2014). “Systolic and diastolic mechanics in stress cardiomyopathy”. Circulation. 129 (16): 1659–67. doi:10.1161/CIRCULATIONAHA.113.002781. PMID 24503950.
- ↑ Park SM, Prasad A, Rihal C, Bell MR, Oh JK (2009). “Left ventricular systolic and diastolic function in patients with apical ballooning syndrome compared with patients with acute anterior ST-segment elevation myocardial infarction: a functional paradox”. Mayo Clin Proc. 84 (6): 514–21. doi:10.1016/S0025-6196(11)60583-1. PMC 2688625. PMID 19483168.
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