A trend of not including electrocardiogram(s) (ECG[s]) in reported cases or series of patients with Takotsubo syndrome (TTS) has recently emerged. Although images of coronary arteriography, contrast ventriculography, transthoracic echocardiography, and cardiac magnetic resonance imaging are included, no data, but instead a description of the ECG, are often provided. A literature search on July 1, 2013, using the MeSH term “takotsubo” revealed 1,681 entries on TTS, with the first contribution published in May 2001. Although all reports on TTS included ECG(s) throughout these 12 years, recently, actual ECGs are shunned, with merely a brief description of what the ECG showed included, or if electrocardiographic data are provided, they consist of a few (not all 12) electrocardiographic leads, with occasionally 1 electrocardiographic lead shown! It goes without saying that at least 2 or even more ECGs are needed in all reports of TTS so that one could appreciate the changes paralleling the clinical course of the illness. This probably reflects the implicit belief of the profession that the ECG in TTS is nonspecific in its features and similar to the one encountered in patients with acute coronary syndromes, particularly acute anterior ST-segment elevation myocardial infarction, from which differentiation is urgently needed for appropriate management implementation.

Review of the most recent 50 entries on July 1, 2013 disclosed the following: (1) no access of 4 reports; (2) no ECG(s) in 18 reports with justification due to the nature of publication (letters to the Editor, reviews, meta-analyses, comments, or primary focus on genetics, hemodynamics, or neuromuscular disorders, or no specific cases presented in detail); (3) 1 review included an ECG unrelated to a specific presented case of TTS; (4) 15 patient cases or series did not include ECGs but a mere brief description of the admission electrocardiographic findings; and (5) 12 patient cases or series included only an admission ECG (10 patients), with 1 patient case report including 4 ECGs of the presented patient and 1 patient case report including only lead V ₄ from serially obtained ECGs. Ten of the 11 complete admission 12-lead ECGs reported reveal low-voltage QRS complexes in some of the limb and precordial leads, a feature recently reported as having some specificity for patients with TTS, either as present on the admission ECG, or developing during the acute phase of the illness.