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?

 

A-Thrombosis 

B-Vasospasm

C-Microvascular dysfunction 

D-Catecholamine surge

 

 

 

 

 

 

 

 

 

 

 

 

 

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.

 

 

https://www.criticalcare-sonography.com/2017/08/15/takotsubo/

 

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