Recognition
• Takotsubo cardiomyopathy → transient left ventricular (LV) dysfunction without obstructive coronary artery disease (CAD)
• Acute coronary syndrome (ACS) mimic
• Apical ballooning on echocardiogram
• Reversible (days–weeks)

Diagnosis
• Treat initially as ACS
• Coronary angiography → no obstructive CAD
• Echocardiogram → apical ballooning, wall motion abnormality beyond single vascular territory
• Cardiac magnetic resonance imaging (MRI) → no late gadolinium enhancement (LGE)

Management
• Initial → ACS protocol (aspirin, anticoagulation, urgent catheterization)
• After diagnosis → ACE inhibitor, beta blocker, diuretics if heart failure
• Anticoagulation if LV thrombus or severe akinesis