Cardiac sympathetic activity in stress-induced (Takotsubo) cardiomyopathy

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 C-11 hydroxyephedrine. Diagnosis. stress-induced (Takotsubo) cardiomyopathy (apical ballooning syndrome). Management. the patient was monitored with cardiac telemetry. Metoprolol and ramipril were continued.