An unusual cause of myocardial infarction.
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An unusual cause of myocardial infarction.
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This 57 year old lady presented with chest pain after a particularly stressdul period in her life. Troponin was 3 and she has a relatively normal 12 lead ecg. I can't upload the movies but here are an
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Forums » Open clinical » Cardiology » An unusual cause of myocardial infarction.
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An unusual cause of myocardial infarction.
posted at 12/9/2011 6:18 PM BST
on bmj.com
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Posts: 328
First: 17/6/2011 Last: 21/2/2012 |
This 57 year old lady presented with chest pain after a particularly stressdul period in her life. Troponin was 3 and she has a relatively normal 12 lead ecg. I can't upload the movies but here are an end-systolic and an end-diastolic frame of the apical 3 chamber view - the apical 2 and 4 look very similar. Any thoughts? 
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Re: An unusual cause of myocardial infarction.
posted at 13/9/2011 11:53 AM BST
on bmj.com
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Posts: 14
First: 18/7/2011 Last: 17/9/2011 |
In Response to An unusual cause of myocardial infarction.: This 57 year old lady presented with chest pain after a particularly stressdul period in her life. Troponin was 3 and she has a relatively normal 12 lead ecg. I can't upload the movies but here are an end-systolic and an end-diastolic frame of the apical 3 chamber view - the apical 2 and 4 look very similar. Any thoughts? Posted by sadian I'm not a qualified doctor so please take what I have to say with a pinch of salt but in my first year I gave a presentation of Broken Heart Syndrome (Takotsubo Cardiomyopathy) I'm sure a more qualified and experienced member can give you more information and please wait for that before making an decisions. Through my reading the literature I found there was little in the way of a rigid set of guidelines for diagnostic characteristics of TTC. Although it is an interesting disease and with my interests leaning slightly further towards the social and caring aspects of medicine rather than the science I thought it was fascinating. The link below is to a case study of a 54 year old patient diagnosed with TTC. It has an example of an ECG readout and a left ventricular angiogram. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1847940/pdf/20070100s00015p76.pdf *edit*I thought because of the stress it could've been TTC and because of the poorly defined characteristics of TTC it was a possibility. Although after reading that you're a consultant cardiologist I think you've probably already considered and decided it wasn't TTC. I'm very interested in what it is though so please when the correct diagnosis is given could you update us? Thanks, Arron |
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Re: An unusual cause of myocardial infarction.
posted at 14/9/2011 8:42 PM BST
on bmj.com
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Posts: 328
First: 17/6/2011 Last: 21/2/2012 |
Hi Arron, I'm impressed with your cardiology knowledge! - we diagnosed this lady with TTC (which goes by a number of names in the literature - broken heart, apical ballooning, stress cardiomyopathy etc). As you say it is often a diagnosis of exclusion . For me the things that pointed towards it were the marked wall motion abnormalities on echo (I think you can appreciate that only the basal segment - the bottom bit thickens) in areas of the heart supplied by all 3 major coronary arteries with a low troponin and the history of emotional stress. She was quite sick developing pulmonary oedema but is now getting better. We did an angio on her yesterday which was normal - we haven't reechoed her yet but I hope her heart will get back to norma. I thought it was an interesting case- hope you agree. best sadian |
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Re: An unusual cause of myocardial infarction.
posted at 17/9/2011 3:26 PM BST
on bmj.com
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Posts: 14
First: 18/7/2011 Last: 17/9/2011 |
I think TTC is fascinating. I think its amazing how intune our bodies our with our emotions and a suddent and complete recovery is another characteristic of TTC. Thank you for keeping us up to date and I wish all the best for you and your patient. Arron |
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Re: An unusual cause of myocardial infarction.
posted at 17/9/2011 9:00 PM BST
on bmj.com
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Posts: 328
First: 17/6/2011 Last: 21/2/2012 |
Thanks for your good wishes Arron - she'll be ready to go home early next week - her left ventricle has not recovered completely on echo yet but I think it will. sadian |
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