This patient's clinical history and presentation are consistent with stress cardiomyopathy (takotsubo cardiomyopathy). The absence of coronary artery stenosis and the presence of hypokinesis of the mid and apical left ventricle on ventriculography confirm this diagnosis. This patient with takotsubo cardiomyopathy without evidence of cardiogenic shock should be administered metoprolol and captopril. The treatment of stress cardiomyopathy is supportive, including the use of β-blockers and ACE inhibitors, and most patients have resolution of symptoms and recovery of left ventricular function within 7 days.

Takotsubo cardiomyopathy often mimics non–ST-elevation myocardial infarction (NSTEMI) or ST-elevation myocardial infarction (STEMI). Patients present with chest pain or shortness of breath, electrocardiographic changes consistent with anterior and/or lateral ST-segment elevation, and elevated cardiac biomarkers. Although not required for diagnosis, many patients develop symptoms following a stressful or emotional event. The diagnosis of stress cardiomyopathy requires (1) ST-segment elevation on electrocardiography, (2) transient wall motion abnormalities of the mid and apical left ventricle, (3) the absence of significant obstructive coronary artery disease, and (4) the absence of other causes of transient left ventricular dysfunction, such as myocarditis.

Endomyocardial biopsy is generally not indicated for the initial evaluation of heart failure unless a specific diagnosis that would influence management or prognosis is suspected based on clinical data or noninvasive testing. This patient's presentation, with acute onset following a stressful event, ST-segment elevation, and hypokinesis of the cardiac apex, is characteristic of takotsubo cardiomyopathy, and an endomyocardial biopsy is not indicated as an initial diagnostic test. Myocarditis has a variable presentation, but focal ST-segment changes and apical hypokinesis are not typical.

More than 95% of patients with stress cardiomyopathy recover ventricular function with conservative supportive care (β-blockers and ACE inhibitors). This patient does not have evidence of hemodynamic compromise, and intra-aortic balloon pump implantation is not indicated.

In this patient, the lack of coronary artery obstructive disease in the presence of ST-segment elevation and elevated cardiac biomarkers eliminates STEMI or NSTEMI as possible etiologies for this presentation. Therefore, thrombolytic therapy is not indicated.