Afghanistan Comprehensive Specialization Exam Practice Questions - Afghanistan Comprehensive Specialization Completion Exam (Takhasus) Exam

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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?

Transmural late gadolinium enhancement (LGE) localized to the distribution of the left anterior descending artery Absence of significant late gadolinium enhancement (LGE) despite extensive myocardial edema on T2-weighted imaging Subepicardial patchy late gadolinium enhancement involving the lateral and inferolateral left ventricular wall Diffuse subendocardial circumferential late gadolinium enhancement not corresponding to any single vascular territory

Correct Answer:

Absence of significant late gadolinium enhancement (LGE) despite extensive myocardial edema on T2-weighted imaging

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