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Takotsubo Syndrome — EECC MCQ

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ModerateCoronary Artery DiseaseTakotsubo SyndromeEECC

A 47-year-old woman is admitted with chest pain. ECG shows ST-segment elevation in V1-V3. She undergoes emergency coronary angiography which reveals normal coronary arteries with no thrombus or dissection. Ventriculography shows apical ballooning with basal hyperkinesis. Troponin I peaks at 1200 ng/L. What is the most likely diagnosis and the recommended imaging modality to confirm it?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Takotsubo syndrome; cardiac magnetic resonance imaging

Explanation lettering: E = shown as A · D = shown as B · B = shown as C · A = shown as D · C = shown as E

The clinical picture of ST elevation with normal coronary arteries and characteristic apical ballooning with basal hyperkinesis is consistent with Takotsubo syndrome. Per the 2023 ESC ACS Guidelines, patients with MINOCA should undergo CMR imaging to establish the underlying cause. CMR can demonstrate characteristic oedema patterns in Takotsubo and exclude myocarditis. Endomyocardial biopsy (A) is invasive and not first-line. OCT (C) would be considered if SCAD were suspected. CTPA (D) assesses for PE. TTE (E) may show wall motion abnormalities but CMR is the gold-standard diagnostic modality.

Reference: ESC (2023): Guidelines for the Management of Acute Coronary Syndromes