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Program

Emergency Medicine

Training Level

Resident PGY 1

Institution

Henry Ford Macomb

Abstract

Takotsubo Cardiomyopathy also known as stress cardiomyopathy is a heart condition in which a type of stress physical or emotional can cause severe weakness of the heart musculature. A 71 y/o F with a history of polycythemia vera, HTN, HLD, and DM presented to the emergency department with a chief complaint of diarrhea x1 week. The diarrhea was associated with two episodes of nausea and vomiting, abdominal cramping, and minimal amount of rectal bleeding. Patient had been worked up for this issue two months prior with negative colonoscopy and biopsy. Physical exam showed mild mid abdominal discomfort on palpation and a negative stool guaiac exam. Lab work subsequently showed that patient had significant hypokalemia, hypomagnesaemia, and a prolonged QT interval on EKG. Patient was started on IV electrolyte replacement and admitted for further electrolyte replenishment. On hospital day 1, the night team was called at bedside to evaluate patient for a new complaint of chest pressure and an impending sense of doom. An EKG was performed which showed no acute changes, but a troponin taken was found to be elevated. Patient was then started on heparin to treat for an NSTEMI. Patient had no known coronary artery disease to this point in her life but did a have a cardiac catheterization years ago in which no cardiac stents were placed. The following morning patient’s repeat EKG showed changes in the anterior leads and her subsequent troponins continued to rise. Patient was transferred to the ICU and cardiology was consulted. Patient was scheduled to have an echocardiogram on hospital day 2 and cardiac catheterization to be performed on hospital day 4. Patient’s echocardiogram showed an ejection fraction of 35% with preservation of the wall motion of the basal left ventricle with dyskinesis of the mid and distal segments of the left ventricle. Her cardiac catheterization showed no obstructive coronary artery disease. This constellation of findings led to a diagnosis of Takotsubo Cardiomyopathy. Patient remained symptom free for the remainder of her clinical course. The patient was discharged home on hospital day 7 and told to continue her current medical management of her symptoms. The patient was advised to follow up with her primary care physician, cardiologist, and nephrologist as an outpatient. This case demonstrates that Takotsubo Cardiomyopathy is often preceded by a stressor but is not always present or apparent what that stressor is. Although this condition was thought to be very rare, the diagnosis and treatment of Takotsubo’s has steadily increased since it was first described. Even though most patients recover, with more research on this condition, hopefully one day we can help prevent it.

Publication Date

5-2019

Takotsubo Cardiomyopathy - More Than Just a Broken Heart?

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