Stress cardiomyopathy is a sudden, usually temporary weakness of the left ventricle, often with ballooning of the apex, triggered by intense emotional or physical stress. It mostly affects postmenopausal women and looks like a heart attack, but the coronary arteries show no blockage.
Key symptoms
- Sudden chest pain after a stressful event
- Shortness of breath
- Palpitations, lightheadedness or fainting
- Sometimes signs of shock
What you find on exam
- May be normal
- Crackles and other signs of heart failure
- Low blood pressure and fast heart rate
- New systolic murmur from outflow tract obstruction
Tests
- ECG: ST elevation or deep T wave inversion, often a long QT
- Troponin mildly raised compared with the large area of weak wall
- Coronary angiography: no blocked artery
- Echocardiogram or ventriculogram: apical ballooning; cardiac MRI to confirm
Treatment basics
- Treat as acute coronary syndrome until angiography rules out a blockage
- Heart failure care: diuretics, then ACE inhibitor and beta blocker when stable
- Outflow obstruction: fluids and beta blocker; avoid nitrates and inotropes
- Anticoagulation if a clot forms in the left ventricle
- Repeat echocardiogram; most recover within weeks
Red flags
- Shock or pulmonary edema
- Long QT with ventricular arrhythmias
- Sudden weakness or speech trouble from a clot
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.