A 62-year-old woman develops acute chest pain and dyspnea hours after the sudden death of her husband. Troponin I is mildly elevated. Coronary angiography shows no obstructive disease. Ventriculography shows akinesia of the apex with compensatory basal hyperkinesis, and the EF is 38%. She recovers fully over four weeks. What is the underlying mechanism attributed to this condition?

• A Embolic occlusion of the left anterior descending artery
• B Microvascular spasm triggered by catecholamine surge ✓
• C Autoimmune lymphocytic infiltration of the myocardium
• D Mutation in the cardiac troponin T gene

Explanation

This is takotsubo (stress) cardiomyopathy: transient apical ballooning with basal hyperkinesis in a postmenopausal woman following emotional or physical stress, with mild troponin rise and normal coronaries. The leading proposed mechanism is a catecholamine surge causing microvascular dysfunction and direct myocyte injury, producing regional stunning that resolves within weeks. Embolic LAD disease would leave persistent apical scar, and neither autoimmune myocarditis nor inherited sarcomere mutation explains the rapid full recovery.

Reference: Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 12th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.