Recurrent stress cardiomyopathy with variable regional involvement: insights into etiopathogenetic mechanisms.

A fifty-nine year old woman presented to a tertiary care center with a few hours of increasing chest pain suspicious for angina. She reported persistent bouts of nausea and vomiting for 2 days before the onset of chest pain, but denied abdominal pain or hematemesis. She denied any recent physical or emotional stressors. Notably, the patient was congenitally deaf, and all history was obtained through a sign language interpreter. Patient also reported chronic cannabis abuse for many years. Physical examination was remarkable for prominent jugular venous pulsation, bilateral lung crackles, and left ventricular gallop, apart from sensorineural hearing loss. Her ECG showed poor R-wave progression, ST-segment elevation, and T-wave inversion in the precordial leads. An echocardiogram revealed a left ventricular ejection fraction of 20% to 25%, severe hypokinesis of apical and midsegments, and hypercontractile basal segments. Laboratory workup revealed elevated troponin-I (2.1 ng/mL) and creatine kinase myocardial band (16.2 ng/mL). Metabolic panel and blood counts were normal. Urine drug screen was positive for tetrahydrocannabinol . Cardiac catheterization revealed normal epicardial coronaries …