Afghanistan Comprehensive Specialization Exam

Practice session

A 64-year-old postmenopausal female presents to the emergency department 2 hours after experiencing severe emotional shock following the sudden death of her spouse. She complains of acute substernal crushing chest pain and shortness of breath. ECG shows 2 mm ST-segment elevations across leads V2–V6 without reciprocal changes. Emergent coronary angiography reveals angiographically normal coronary arteries without plaque rupture, thrombosis, or focal spasm. Left ventriculography demonstrates marked apical and mid-ventricular akinesis with basal hyperkinesis ('apical ballooning') and an estimated left ventricular ejection fraction of 30%. Cardiac magnetic resonance (CMR) imaging is scheduled. What is the characteristic CMR finding that differentiates this condition from acute myocardial infarction and acute myocarditis?

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