Prophylactic anticoagulation may be considered to inhibit the development of LV thrombi. (Level of Evidence: C) Stress (Takotsubo) cardiomyopathy (also referred to as tran- sient LV apical ballooning or Takotsubo cardiomyopathy) mimics NSTE or STEMI.799 803 There is no obstructive CAD, and the distribution of electrocardiographic changes and LV wall motion abnormalities usually includes >1 coronary artery Cardiac troponin elevations are usually modest.798 The majority of cases occur in postmenopausal women, and presentation is typically precipitated by emotional or physi- cal stress. Imaging by echocardiography, ventriculography,696 or magnetic resonance imaging699 demonstrates characteristic hypokinesis or dyskinesis of the LV apex with basilar increased contractility. Variants include hypokinesis of the mid or base of the left ventricle,795 and right ventricular involvement is com- In the vast majority of patients, electrocardiographic and LV wall motion abnormalities normalize within 1 to 4 weeks, and recurrences are uncommon.805 The pathogenesis has been attributed to excess catecholamine release,803 coro- nary spasm, or small coronary vessel hypoperfusion.806 Care is predominantly supportive and includes beta block- ers, vasodilators, and catecholamines. The latter 2 interven- tions must be used cautiously, because they may induce outflow tract obstruction.800 If shock is present, IABP can be used. Prophylactic anticoagulation should be considered to prevent or treat LV thrombus.798 Amsterdam et al 2014 AHA/ACC NSTE-ACS Guideline e393 Obesity is associated with conditions such as dyslipidemia, diabetes mellitus, hypertension, arrhythmias, and HF that adversely affect ACS outcomes. In the MADIT (Multicenter Automatic Defibrillator Implantation)-II trial, there was an inverse relation between body mass index and both all-cause mortality and sudden cardiac death in patients with LV dys- function after MI.807 In the SYNERGY trial of 9837 patients with NSTEMI, mortality was lower in morbidly obese patients, consistent with the obesity paradox. 