A 58-year-old woman develops severe retrosternal chest pain hours after receiving news of her husband's death. ECG shows ST elevation in anterior leads, troponin is mildly raised, and coronary angiography reveals unobstructed arteries. Ventriculography shows basal hyperkinesis with apical akinesis and ballooning. The most likely diagnosis is:
- A Anterior myocardial infarction with spontaneous reperfusion
- B Acute fulminant myocarditis
- C Takotsubo (stress) cardiomyopathy ✓
- D Coronary artery spasm
Correct answer: C. Takotsubo (stress) cardiomyopathy
Explanation
The combination of emotional stress, transient anterior ST elevation, mild troponin rise out of proportion, normal coronaries, and apical ballooning with basal hyperkinesis defines takotsubo cardiomyopathy. It is thought to follow a catecholamine surge and typically recovers within weeks. Anterior infarction requires a culprit lesion or territory abnormality persisting beyond the acute phase, and spasm would show focal reversible narrowing on angiography.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.