Stress cardiomyopathy other diagnostic studies

Coronary angiography and cardiac catheterization are the diagnostic modalities of choice to distinguish between stress cardiomyopathy and acute anterior MI. Normal anatomy of the coronary arteries, along with a reduced ejection fraction supports the diagnosis of stress cardiomyopathy.

When patients with stress cardiomyopathy undergo cardiac catheterization, the following findings are usually reported:^[1][2][3]

• Normal anatomy of the coronary arteries, without evidence of acute plaque rupture
• Low ejection fraction (EF)
• Minimal or no evidence of coronary vasospasm
• Minimal disturbance of microcirculation

• Myocardial biopsy, although not necessary for diagnosis, can distinguish between stress cardiomyopathy and MI.
• The histological findings on myocardial biopsy in patients with stress cardiomyopathy include:^[4][1]

• Inflammatory infiltrates, consisting of mononuclear lymphocytes, leukocytes and macrophages
• Myocardial fibrosis
• Contraction bands, which may or may not be associated with necrosis
  

• The combination of inflammatory changes and contraction bands distinguish stress cardiomyopathy from coagulative necrosis seen in MI.^[4]

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