Stress cardiomyopathy in a Caucasian man

Stress cardiomyopathy is increasingly being described as a form of reversible left ventricular systolic dysfunction, with a characteristic shape on left ventriculography. The acute clinical, electrocardiographic and laboratory abnormalities are reminiscent of acute coronary syndrome, with nonobstructive coronary arteries on angiography. Wall motion abnormalities typical of this disease exhibit apical akinesis with compensatory basal hyperkinesis, resulting in the characteristic systolic apical ballooning. Stress cardiomyopathy is much more common in women than men, especially postmenopausal women, and it is typically triggered by intense medical, emotional or physical stress. The pathogenesis of the disease is not well understood, with current evidence favouring catecholamine myocardial injury. Until prospective distinction can be made between stress car-diomyopathy and acute coronary syndrome, the diagnosis should be that of exclusion. In addition to long-term beta-blockers, angiotensin-converting enzyme inhibitors and diuretics as needed, treatment is generally supportive, with recovery of baseline left ventricular function within a few weeks to a month.