Board Review: Cardiology
A 90 y/o female with a history of osteoarthritis and recent loss of her daughter presented to the ED for nausea, vomiting, left-sided chest pain, and difficulty breathing. Her initial troponin was 2.3. Her EKG showed t-wave inversions in the inferior and lateral leads. Her bedside TTE reveals a diffusely hypokinetic and dilated LV. She went to the cath lab which showed non-obstructive coronary artery disease on angiography. What is not a proposed mechanism for the cause of this patient’s presentation?
Answer: A.This patient has Takotsubo cardiomyopathy which is characterized as a transient depression in LV systolic function that often mimics acute MI, but with non-obstructive coronaries on angiography. Proposed mechanisms include vasospasm, microvascular dysfunction, and abnormal myocyte response to catecholamine surge.
Diagnosis of TCM is made by the Mayo Clinic diagnostic criteria, all of which need to be present to make the diagnosis:
-Transient LV systolic dysfunction
-Absence of obstructive coronary disease or acute plaque rupture on angiography
-New EKG changes OR modest elevation in cardiac troponin
-Absence of pheochromocytoma or myocarditis
Bybee KA, Kara T, Prasad A, Lerman A, Barsness GW, Wright RS, Rihal CS. Systematic review: transient left ventricular apical ballooning: a syndrome that mimics ST‐segment elevation myocardial infarction. Ann Intern Med. 2004;141:858–865
Templin C, Ghadri JR, Diekmann J et al. Clinical features and outcomes of Takotsubo (Stress) cardiomyopathy. New Eng J Med. 2015;373:929–38. doi: 10.1056/NEJMoa1406761
Sharkey, S., Lesser, J., & Maron, B. (2011). Takotsubo (stress) cardiomyopathy. American Heart Association.
AUTHOR: TARA KNOX