A 65 year old Female Presents to the ED with a complaints of severe chest pain. Her medical history is significant for HTN, DM, HLD. The patient states the pain started after she was told Derek Jeter was going to retire
Her EKG is below
As the patient is being wheeled to the cath lab, this picture suddenly comes to mind…
2 hours later, as you look up the cath results, you see that no lesions were found, but the report mentions something called apical ballooning. What is the diagnosis?
The patient has takotsubo cardiomyopathy or transient left ventricular apical ballooning syndrome. It is a disease characterized by a STEMI on EKG, but clean coronaries on cath. It predominately effects women >90%. Also it is usually brought on by a emotional or stressful event. Patient usually recover fully in 1-4 months. However, this disease is extremely difficult to ditinguish from a STEMI. Ekg’s have been described as
“The most common acute ECG findings are ST segment
elevation in the precordial leads and T wave inversions in most
leads.2–3,5,15–20 Evolving T waves deepen further to their first
negative peak within 3 days, transiently turn shallow, then
become significantly deeper on their second negative peak in
2–3 weeks.21,22 T wave changes may revert to normal after
about 2–4 months.3,22 Prolongation of corrected QT (QTc)
interval may occur 48 hours from symptom onset23 or may
accompany the second phase of T wave inversions22. Q waves
in leads V1-V2 or V2-V3 are present in 56% of cases.
Treatment is mainly supportive with concern for APE or carcinogenic shock. Patient’s also require an echo to evaluate for thrombus formation in the ventricle.
Buchholz S, Rudan G. Tako-tsubo syndrome on the rise: a review of the
current literature. Postgrad Med J. 2007;83:261–4
Pilgrim TM, Wyss TR. Takotsubo cardiomyopathy or transient left
ventricular apical ballooning syndrome: A systematic review. Int J