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A 51-year-old man with hypothyroidism, no prior cardiovascular history presented with acute chest pain and dyspnea. Electrocardiography revealed ST-segment elevation in AVR and diffuse T wave inversion. high-sensitivity troponin levels were elevated. Emergency coronary angiography demonstrated unobstructed coronary arteries. Left ventriculography revealed apical ballooning with basal hyperkinesis, consistent with Takotsubo (stress-induced) cardiomyopathy (Panel A, video in Supplementary Appendix). Transthoracic echocardiography confirmed the apical and mid akinesis and reduced EF 35-40% (Panel B).

The patient was treated with supportive medical therapy, including beta-blockade, ACE, Aldactone. His symptoms resolved, and discharged to ambulatory follow-up.

Takotsubo cardiomyopathy accounts for approximately 1-2% of patients presenting with suspected acute coronary syndrome. It predominantly affects postmenopausal women, but cases in men, although less common, may be associated with worse outcomes. Recognition of the syndrome is important to avoid unnecessary interventions and to guide supportive management.