Mayo Clinic, Rochester, Rochester, MN 55905, USA.
BACKGROUND: A 54-year-old postmenopausal woman presented with retrosternal chest pressure, nausea, and vomiting of 4 h duration. Her medical history included hypertension (treated with metoprolol and ramipril), hyperlipidemia (treated with atorvastatin), and depression (treated with fluoxetine). A few hours before symptom onset, she had witnessed an accident in which her sister sustained serious injuries. The patient was visiting her sister-who was in critical condition in the hospital-when the symptoms began. INVESTIGATIONS: Physical examination, chest radiography, laboratory testing, electrocardiography, coronary angiography, and PET with 11C hydroxyephedrine. DIAGNOSIS: Stress-induced (Takotsubo) cardiomyopathy (apical ballooning syndrome). MANAGEMENT: The patient was monitored with cardiac telemetry. Metoprolol and ramipril were continued.