September 17, 2015

Is this a STEMI? - Takotsubo cardiomyopathy

A patient was admitted due to weakness. What do you think of the ecg? Is this a STEMI?

Image 1

There are ST elevations in V1 to V3 (anterior wall STEMI). It may also look like pericarditis because of PR depressions but those were noise. T waves in V2 and V3 seem tall but not the classic tentted T waves in hyperkalemia and the K was normal in this case.

The troponin came back elevated so a coronary angiogram was done. Heart cath did not reveal an significant stenonis. LV cardiogram consistent with Takotsubo cardiomyopathy. Supportive management was done and patient was discharged a few days.

This was a case of Takotsubo cardiomyopathy. This is also called transient apical ballooning and stress cardiomyopathy. It is a reversible cardiomyopathy with a clinical presentation indistinguishable from myocardial infarction. It commonnly occurs in postmenopausal women. Transient ST elevations can be seen on the ECG and there is modest elevation in troponins. Ventricular dysfunction is shaped like takotsubo and there is absence of obstructive coronary lesion. The dysfunction improves rapidly within a few weeks.

Here are links on Takotsubo cardiomyopathy:

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