**Introduction/Hypothesis:**
A 60-year-old female with history of COPD on 2L of oxygen at baseline presented to emergency department with worsening dyspnea. In the ER, the patient was in respiratory distress and tested PCR positive for influenza A. Additional laboratory values were significant for elevated lactate 8.9, leukocytosis WBC 17.5, and troponin T mildly elevated at 36. A Triple rule out CT with coronary angiography and retrospective gating was performed which demonstrated apical akinesis with ballooning, preserved basal contraction and an apical left ventricular thrombus. The coronary arteries demonstrated minimal atherosclerotic disease with minimal stenosis. This was most apparent on a specialized 512 Matrix Cine reconstruction series which was possible due to retrospective gating. Left ventricular ejection fraction was estimated at 24%. Subsequent echocardiogram confirmed the findings seen on the CT. The patient was treated for influenza and COPD exacerbation and discharged from the hospital 10 days later. The patient completed a 3-month prescription of coumadin for the left ventricular thrombus. Follow-up echocardiogram 3 months later demonstrated normal LV size without wall motion abnormalities. Cardiac MRI 6 months after initial presentation demonstrated normal LV size and global systolic function. No residual thrombus was present. Interestingly, the patient had a prior episode of stress induced cardiomyopathy 4 years prior with apical dyskinesia and reduced LVEF of 25% with subsequent recovery of function and normal cardiac MRI in the interim.

**Methods**


**Results**
This case demonstrates the utility of retrospectively gated triple rule out CT to diagnose stress induced cardiomyopathy. A few notable advantages of retrospective coronary CT in the setting of possible stress induced cardiomyopathy include relatively quick acquisition (compared with echocardiography, conventional angiography and MRI), simultaneous evaluation of coronary arteries, and the ability to assess wall motion abnormalities with 512 matrix cine images (1). Assessment for interventricular thrombi can be performed utilizing multiplanar reformats which can overcome the possible issue of poor acoustic windows on echocardiography. In stable patients with low suspicion of ACS and high suspicion of new or recurrent stress induced cardiomyopathy, coronary angiogram CT may be chosen instead of conventional coronary angiography (2). A disadvantage of using CT rather than MRI or echocardiography is exposure to ionizing radiation, however the dose is presumably less than conventional coronary angiography (3).

**Conclusion**
In conclusion, retrospectively gated triple rule out CT with coronary computed tomography angiography can be used to diagnose stress induced cardiomyopathy. This diagnosis can be aided by utilizing cine imaging to evaluate wall motion abnormalities.
1. Zghyer F, Botheju WSP, Kiss JE, Michos ED, Corretti MC, Mukherjee M, Hays AG. Cardiovascular Imaging in Stress Cardiomyopathy (Takotsubo Syndrome). Front Cardiovasc Med. 2022 Jan 28;8:799031. doi: 10.3389/fcvm.2021.799031.
2. Citro R, Okura H, Ghadri JR, Izumi C, Meimoun P, Izumo M, Dawson D, Kaji S, Eitel I, Kagiyama N, Kobayashi Y, Templin C, Delgado V, Nakatani S, Popescu BA. Multimodality imaging in takotsubo syndrome: a joint consensus document of the European Association of Cardiovascular Imaging (EACVI) and the Japanese Society of Echocardiography (JSE). J Echocardiogr. 2020 Dec;18(4):199-224. doi: 10.1007/s12574-020-00480-y. Epub 2020 Sep 4. Erratum in: J Echocardiogr. 2020 Dec;18(4):225. doi: 10.1007/s12574-020-00503-8.
3. Aupongkaroon P, Makarawate P, Chaosuwannakit N. Comparison of radiation dose and its correlates between coronary computed tomography angiography and invasive coronary angiography in Northeastern Thailand. Egypt Heart J. 2022 Jan 25;74(1):6. doi: 10.1186/s43044-022-00241-5.



Stress Induced Cardiomyopathy diagnosed on CT 

This course will explore basic and cutting-edge imaging techniques to improve patient care and hone individual skills in performance and interpretation of echocardiography, nuclear cardiology, cardiac computed tomography, and cardiovascular magnetic resonance imaging. Days will reinforce how cardiovascular imaging may improve comprehension in ischemic heart disease, structural heart disease, cardiomyopathies, and heart failure. Experts will utilize novel techniques to reinforce key topics including taped interventional cases and a strong emphasis on case presentations.