Table 2 Paraclinical tests differences between TC and AMI
TC | AMI | |
|---|---|---|
1.Laboratory tests | ||
Cardiac biomarkers | ||
Troponin T/I | Mildly/moderately increased | Markedly increased |
BNP, NT-proBNP | Markedly increased | Mildly increased |
Inflammatory markers | ||
Leukocytosis | Present | Present |
CRP | increased | Increased |
Serum catecholamines | increased | Normal |
2.ECG | ||
ST-segment | -ST-segment elevation > 1 mm in precordial leads without reciprocal ST-segment depression in inferior leads -ST-segment depression—less frequent | -ST-segment elevation in at least 2 contiguous leads with reciprocal ST-depression in inferior leads -ST-segment depression (horizontal/down-slope) > 0.5 mm in 2 contiguous leads |
T wave | T wave inversion in the anterior leads | T wave inversion in 2 contiguous leads with R > S |
Q wave | Without Q waves | Present |
QT segment | Prolonged | Normal |
Arrhythmias | Monomorphic/polymorphic ventricular tachycardia Ventricular fibrillation Torsade’s de points | Monomorphic/polymorphic ventricular tachycardia Ventricular fibrillation Torsade’s de points |
Atrioventricular block | May be present | May be present |
Bundle branch block | Absent | Left/right bundle branch block may be present |
1.Echocardiography | ||
LV systolic function | Acute phase: Temporary reduced Long-term: complete recovery | Acute phase: Reduced Long-term: complete/partial recovery or persistent LV dysfunction |
LV wall motion abnormalities | RWMA not limited to an epicardial coronary artery territory LV apical ballooning pattern Mid-ventricular pattern ballooning ± SAM—uncommon Basal ballooning pattern—uncommon Focal pattern | RWMA limited to an epicardial coronary artery territory |
Complications | LV thrombus Mitral regurgitation LV free wall rupture | Apical aneurysm LV thrombus Mitral regurgitation LV free wall rupture |
6. CMR | ||
T2 | Acute phase: transmural myocardial edema Subacute phase: fine remaining RWMA | Myocardial edema RWMA |
LGE | Acute phase: transmural areas of LGE uptake at the hinge between akinetic/dyskinetic ballooning segments and hypercontractile segment, but no persistent LGE on long-term | Focal subendocardial/transmural LGE uptake |
EGE | LV thrombi | LV thrombi |
7. Coronary computed tomography angiography | ||
Normal epicardial coronary arteries/non-obstructive CAD | Obstructive CAD | |
8. Coronary angiography | ||
Coronary angiography | Normal epicardial coronary arteries Non-obstructive CAD (stenosis < 50%) | Obstructive CAD (stenosis ≥ 50%) MINOCA |
Ventriculography | LV mid- and apical segments akinesis and hypercontractility of the basal segments | – |
Invasive hemodynamics | LVOTO (20% of patients) Increased LVEDP | Increased LVEDP |