A 61-year-old woman develops acute chest pain and dyspnea hours after learning of her husband's death. ECG shows ST-segment elevation in the anterior leads. Troponin I is mildly raised at 0.9 ng/mL. Coronary angiography shows unobstructed vessels. Ventriculography reveals apical akinesia with ballooning and basal hyperkinesis, with LVEF 38%. What is the most likely diagnosis?

• A Takotsubo syndrome ✓
• B Anterior ST-elevation myocardial infarction with distal embolisation
• C Myocarditis
• D Spontaneous coronary artery dissection

Explanation

Takotsubo syndrome classically affects postmenopausal women after intense emotional or physical stress, mimicking STEMI with mild troponin elevation disproportionate to the wall motion abnormality. Normal coronaries plus reversible apical ballooning with basal hyperkinesis (the apical ballooning pattern) confirm it; most patients recover systolic function within weeks. Myocarditis usually shows diffuse rather than regional apical dysfunction, SCAD would show a coronary lesion on angiography, and true anterior MI requires a culprit vessel.

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

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Written and medically reviewed by the StethoPrep medical team.