A 65-year-old woman went to her daughter's wedding. The chest pain started afterward and lasted three days before she sought care, and when she did, her electrocardiogram showed ST-segment elevation across the anterolateral leads, and her troponin came back at 717 nanograms per liter.
She was referred urgently to a tertiary hospital and taken for coronary angiography. Her arteries were clean. What the left ventriculogram showed instead was the base of her heart squeezing hard while the tip ballooned outward and refused to contract. Her ejection fraction had fallen from 58 percent five months earlier to 35 percent.
