Takotsubo Cardiomyopathy

Broken

Step 1: View clinicals

A 65 year old woman presents with severe chest discomfort and mild dyspnea for 30 minutes, which started soon after she learnt that her husband had died in a car accident. She was in good health previously, with no known medical conditions. Her surgical history is significant only for an appendectomy at age 25.


Step 2: Order all relevant investigations

ECG

The ECG is in sinus rhythm, with a rate of 104 bpm. There are ST-segment elevations of 3 mm in Leads V1-V3, Lead I, and aVL.

Cardiac Troponins

Troponin-T: 3.3 ng/mL (< 0.1 ng/mL) Troponin-I: 5.9 ng/mL (< 0.2 ng/mL)

Bedside Echocardiogram

There is regional systolic dysfunction of the left ventricle, with hypokinesis of the middle and apical segments and hyperkinesis of the base. The ejection fraction is 40%. No other abnormalities are noted.

Coronary Angiography

All coronary arteries are patent, with no evidence of spasm or thrombosis. Ventriculography shows apical ballooning with hyperkinesis of the basal segments and hypokinesis of the apical segments of the left ventricle.


Step 3: Select appropriate management

Beta Blockers
Thrombolysis
ACE Inhibitors
Inotropes


Score: ★★☆