A 32-year-old woman presents with acute dyspnea and chest pain 2 days after an emotional stressor. ECG shows ST elevation in leads V2-V5. Troponin is elevated at 4.5 ng/mL. Echocardiogram shows apical ballooning of the left ventricle with basal hyperkinesis and LVEF 35%. Coronary angiography reveals normal coronaries. Which is the most likely diagnosis?
- A Anterior STEMI with spontaneous recanalization
- B Myocarditis
- C Takotsubo (stress) cardiomyopathy ✓
- D Cocaine-induced coronary vasospasm
Correct answer: C. Takotsubo (stress) cardiomyopathy
Explanation
Takotsubo cardiomyopathy classically presents in postmenopausal or stressed women with acute chest pain, ST elevation, troponin rise, and apical ballooning on echo with normal coronaries. The emotional trigger, female sex, and characteristic wall motion abnormality limited to the apex with basal hyperkinesis are pathognomonic. Myocarditis can mimic this but typically shows more diffuse wall motion abnormalities and often a viral prodrome. Normal coronaries with this specific wall motion pattern excludes occlusive coronary disease.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.