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Question: A 67-year-old woman presents to the emergency room with acute chest pain and dyspnea after the death of her husband. She is hypotensive, tachycardic, and diaphoretic. A diagnosis of takotsubo cardiomyopathy is suspected. Which of the following findings best confirms this diagnosis?

a) ST-segment elevation
b) Normal coronary arteries
c) New systolic murmur
d) Elevated serum troponin

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Answer: Normal coronary arteries. The diagnosis of takotsubo, or stress-induced cardiomyopathy, should be suspected in post-menopausal women with acute heart failure or cardiogenic shock following an emotionally stressful event. Common precipitants include death or injury of a loved one. Takotsubo cardiomyopathy is most commonly characterized by left ventricular systolic dysfunction and the absence of significant coronary artery disease. Treatment is supportive and patients generally improve within four weeks.

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