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Discovering Takotsubo Syndrome with Cardiac Magnetic Resonance

Raquel Menezes Fernandes, João Guedes, Teresa Mota, Hugo Costa, João Bispo, Pedro Azevedo, Dina Bento and Nuno Marques

Reversible left ventricle dysfunction is a key feature of Takotsubo syndrome (TTS), but the differentiation between acute cardiac syndromes at admission could be a significant challenge. Despite the wide accessibility of echocardiography, cardiac magnetic resonance (CMR) is emerging as unique tool to accurately assess this entity, through its detailed morphological, functional and tissue characterization. Typical wall motion abnormalities, pattern and distribution of edema and even of low-intensity late gadolinium enhancement are singular findings of TTS on CMR. Therefore, it should be considered to perform CMR during hospitalization and at follow-up, facilitating the differential diagnosis with myocarditis and acute myocardial infarction, and consequently patient management. Despite all the imaging advances made so far, evaluation of coronary anatomy remains mandatory in patients with ST-segment elevation.