Important echocardiographic features of takotsubo or stress-induced cardiomyopathy that can aid early diagnosis.

n regards to the recently published paper by Hurst et al. (1), I would ike to emphasize some of the classic echocardiographic features that re useful for early diagnosis of stress cardiomyopathy (2). In the classic ase, the most important feature is apical ballooning involving all left entricular (LV) walls with a hyperdynamic base, not limited to any ingle coronary territory (Fig. 1). The diagnosis of apical ballooning yndrome should be strongly considered based on this echocardioraphic feature in conjunction with clinical data. In selected cases, it s reasonable to defer coronary angiography and wait for full ecovery of LV function in a few days or weeks by repeating chocardiography. The second most important feature is involveent of the right ventricular apex in the same manner as the LV pical involvement. This feature occurs in approximately one-fourth