A 74-year-old woman arrived at a British emergency department with chest pain after an emotional shock. Her high-sensitivity troponin peaked at 2232 ng/L against a normal range below 18. Her bedside echocardiogram showed the ballooned apex that defines takotsubo syndrome, with a pumping fraction of 45%, and a CT scan of her coronary arteries found narrowings but nothing obstructive enough to explain the picture. So far, a textbook case of broken heart syndrome, a stress-triggered condition that usually resolves.
A month later, a cardiac MRI came back describing features consistent with apical hypertrophic cardiomyopathy, a genetic disease of thickened heart muscle that carries lifelong implications. Her apex measured 15 millimeters, compared with 7 millimeters at the base. A second MRI three months later agreed. Only a third study, 15 months after she first walked in, showed the thickened segments had completely resolved and pointed back to takotsubo.
