A woman in her 60s with hypertension and hyperlipidemia presented with chest pain for 3 days. She denied any cardiac history but reported intermittent substernal chest pain for the past few months that had worsened in the past week. She denied associated symptoms. Her vital signs and cardiopulmonary examination results were within normal limits; her baseline electrocardiogram (ECG) is shown in Figure 1. Initial troponin level was 0.33 µg/L. Her chest pain resolved after administration of sublingual nitroglycerin, and her troponin level decreased to 0.1 µg/L. Given the patient’s elevated cardiac enzymes, she was admitted for treatment of non-ST elevation myocardial infarction. Twelve hours after admission, the patient had another episode of substernal chest pain with troponin elevation to 0.3 µg/L. An ECG recorded at that time is shown in Figure 2. She was treated with nitrates, and her chest pain resolved. Another ECG was obtained after her pain resolved and her subsequent troponin measurements trended down (Figure 3).
Sinha A, Rassiwala J, Goldschlager N. Takotsubo CardiomyopathyHow T Waves Behave Under Stress. JAMA Intern Med. 2015;175(5):842-844. doi:10.1001/jamainternmed.2015.52