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+A woman in her early 70s presented to our emergency room 30 min after her husband expired with 8/10, substernal chest pain with concurrent diaphoresis and dyspnoea.
+The patient's husband had an out-of-hospital cardiac arrest earlier that day and was brought to our emergency room and subsequently admitted to the coronary care unit.
+He had recurrent ventricular fibrillation and could not be successfully resuscitated.
+The patient's medical history included hypertension and hypothyroidism.
+She denied having had a similar episode of pain.
+She had regular appointments with her primary care physician.
+Her medication included oral furosemide 20 mg and levothyroxine 100 µg, both once daily.
+She denied allergies.
+On presentation, the patient was afebrile, with a blood pressure of 105/55, heart rate of 93 bpm, respiratory rate of 20/min and an oxygen saturation of 98% on room air.
+On physical examination, she was in significant distress due to pain.
+Her skin was warm and moist, with minimal crackles in bilateral bases, regular rate and rhythm, 2/6 systolic murmur of the apex without radiation, no rubs, elevated jugular vein distention of 8 cm, strong peripheral pulses and no peripheral oedema.
+The abdomen was soft, non-tender, non-distended, with bowel sounds, and the patient was alert and oriented without focal neurological deficits.
+The complete blood count, basic metabolic panel and coagulation tests were within normal limits.
+The cardiac enzymes were increased with a troponin I of 2.59 ng/mL (normal range 0.015–0.045 ng/mL), creatine phosphokinase of 84 U/L (normal range 26–192 U/L).
+ECG on admission revealed normal sinus rhythm with 2–3 mm ST segment elevations in leads V2–V3 and Q waves in leads V1–V3, suggestive of anterior wall infarct (figure 2).
+An echocardiogram revealed left ventricular ejection fraction of 30–35% with mild concentric left ventricular hypertrophy, akinesis of the apex and 2/3 of the inferoseptum and apical inferior-anterior wall segments, suggesting ischaemic damage at the left anterior descending artery distribution versus takotsubo cardiomyopathy (figures 3 and ​4).
+The patient received aspirin 162 mg and prasugrel 60 mg, and was taken to the cardiac catheterisation laboratory.
+The angiogram showed non-obstructive coronary artery disease with luminal irregularities (figures 5 and ​6).
+The left ventriculography showed an ejection fraction of 35% with akinesis of apical wall and hyperkinesis of basal segments (figures 7 and 8).
+The patient remained haemodynamically stable and was started on oral heart failure medications, including lisinopril 2.5 mg daily and metoprolol tartrate 12.5 mg two times a day.
+Her pain and shortness of breath resolved and she was discharged home after 48 h of hospitalisation in stable condition.
+A repeat echocardiogram 2 months later showed resolution of her cardiomyopathy and an ejection fraction of 65–70%, with normal left ventricular motion.