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Notes
1 * A very small group of individuals have heterophile antibodies that agglutinate with the murine antibodies used in the troponin assay, causing the very rare “falsely positive troponin elevation”. These patients have chronic troponin elevation, sometimes severe, discrepant with the stable clinical setting. An alternative troponin assay or a special heterophilic blocking reagent is used for confirmation.
2 ** Late gadolinium enhancement and/or edema on T2 may be seen with myocarditis or infarction. Only edema may be seen in takotsubo, not late gadolinium enhancement. The distribution of the anomaly distinguishes myocarditis from an ischemic pattern:26Distribution not consistent with an arterial territory + subepicardial or mid-wall predominance → myocarditisDistribution consistent with an arterial territory + subendocardial or transmural