A 58-year-old woman presents with acute chest pain and dyspnea hours after learning of her son's death. ECG shows ST elevation in precordial leads. Troponin is mildly raised. Coronary angiography shows normal epicardial arteries. Left ventriculography during systole shows basal hyperkinesis with ballooning of the apex. What is the diagnosis?

• A Anterior STEMI with spontaneous reperfusion
• B Acute lymphocytic myocarditis
• C Microvascular angina
• D Takotsubo cardiomyopathy ✓

Explanation

Takotsubo (stress) cardiomyopathy affects postmenopausal women after a catecholamine surge from emotional or physical stress. The hallmark is a regional wall motion abnormality that extends beyond the territory of a single coronary artery, classically apical ballooning with basal sparing, with normal coronaries and a troponin rise disproportionately small for the degree of dysfunction. Recovery is expected within days to weeks. An LAD occlusion would respect the LAD territory.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.