Takotsubo cardiomyopathy or myocardial infarction? Answers from delayed enhancement magnetic resonance imaging

Takotsubo cardiomyopathy (TTC) mimics symptoms of acute myocardial infarction (MI) with transient left ventricular dysfunction, acute chest pain, electrocardiographic changes and minimal myocardial enzyme release in the absence of significant coronary artery disease. We describe the cases of two postmenopausal women with suspected MI undergoing coronary angiography. Both patients had unobstructed coronary arteries but left ventriculography showed apical ballooning. Delayed enhancement magnetic resonance imaging (MRI) revealed in one patient transmural enhancement in the distribution of a coronary artery compatible with MI and in the other patient no delayed enhancement consistent with viable myocardium and the diagnosis of TTC. Therefore cardiac MRI should be performed in all patients with suspected TTC for further differential diagnosis.