Tako-tsubo-like cardiomyopathy is rare. It is recognised generally to affect middle aged or postmenopausal women after a significant stressful physical or psychological insult. Tako-tsubo, from the Japanese meaning “octopus trap”, describes the shape of the left ventricle during systole with basal contraction and apical akinesia. Prognosis is usually good with most patients recovering spontaneously.

A 59-year-old women was admitted with severe left-sided chest pain and dyspnoea. An ECG was performed (panel A) and showed widespread T-wave inversion in inferior and anteroseptal leads. The picture was consistent with an acute coronary syndrome and she was treated with aspirin, GTN, clopidogrel, a β-blocker and a statin. Troponin T was raised at 0.43 μg/l (normal <0.03).

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Coronary angiography showed normal coronary anatomy. A left ventriculogram (in diastole (panel B) and systole (panel C) with apical akinesis) demonstrated a large apical wall motion abnormality. Echocardiography at 6 weeks showed improved apical contraction. Interestingly, at follow-up she confirmed that her symptoms had started after a fierce argument with a close family member.

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