Epidemiology

• 90% of affected individuals are postmenopausal women.
• More common in patients with preexisting mental illness

Etiology

Pathophysiology

• Emotional/physical stress → activation of the sympathetic nervous system → massive catecholamine discharge → cardiotoxicity, multivessel spasms, and dysfunction → myocardial stunning
  • A state of abnormal regional LV wall motion that persists for hours to weeks following transient ischemia

Clinical features

• Patients typically have chest pain that can mimic a myocardial infarction and may also have symptoms of heart failure (eg, dyspnea, lower extremity swelling).
• ECG often shows evidence of ischemia (eg, ST elevation, T-wave inversion) in the anterior precordial leads; however, coronary angiography typically reveals an absence of obstructive coronary artery disease.
• The condition usually resolves within several weeks with supportive treatment only.

Diagnostics

Echocardiography (TTE)

• Global LV dyskinesis involving the apex (most common)
• Regional wall motion abnormalities
  • Apical left ventricular ballooning (not always present)

Treatment