Regional wall-motion abnormality beyond one coronary territory (apical ballooning most often) with oedema in the same segments and NO infarct-pattern LGE — after unobstructed coronaries — separates Takotsubo from infarction and myocarditis.
Orient first
- Typically postmenopausal women after emotional or physical stress; ECG and troponin mimic infarction.
- Variants: apical (commonest), midventricular, basal (inverted), focal.
- Recovery over weeks confirms the diagnosis.
Acquire the study
- CMR: cine (short-axis stack and long axes), T2-weighted STIR or T2 mapping, native T1, LGE.
The manoeuvre
- Cine long-axis series: apical ballooning with hyperkinetic base; EF in %.
- T2 mapping or STIR: oedema matching the dysfunctional segments.
- LGE series (PSIR): absent (or faint, not subendocardial infarct pattern).
- LV thrombus in the akinetic apex; LVOT obstruction; RV involvement.
What confirms it
- Typical wall-motion pattern with matching oedema, no infarct LGE, unobstructed coronaries, and recovery.
What licenses you to exclude it
- Subendocardial LGE in a coronary territory indicates infarction (including MINOCA), not Takotsubo.
The classic misread
- Missing an apical thrombus.