Takotsubo Cardiomyopathy: A Nuclear Cardiology Viewpoint
The patient is a 65-year-old woman with a medical history of hypertension, supraventricular tachycardia, prior tobacco use, right renal cell carcinoma (status post partial nephrectomy), metastatic right breast invasive ductal carcinoma (status post segmental mastectomy), complete axillary dissection, and breast reconstruction who was hospitalized for bilateral breast cellulitis requiring breast implant exchange and developed post-operative asymptomatic paroxysmal supraventricular tachycardia with heart rate up to 161 bpm. At presentation, her physical exam was remarkable for bilateral surgical wounds in the breast area. An electrocardiogram showed anterolateral and inferior T-wave inversions. Troponin I was elevated at 0.79 ng/mL, and creatine kinase-muscle/brain was elevated at 7 ng/mL. An echocardiogram was technically difficult, and left ventricular (LV) function assessment was limited. A nuclear stress test was obtained (Figures 1-2).
Regarding the single-photon emission computed tomography (SPECT) images, which of the following is the best interpretation and next step in management?