Wednesday, December 31, 2008

Octopus

A 60 year old postmenopausal woman who recently had an unexpected death of her husband in a car accident presents with acute-onset severe crushing left sided substernal chest pain radiating to the arm and neck, diaphoresis, and nausea. EKG shows ST segment elevation and cardiac enzymes are mildly elevated. She is rushed to the cath lab. However, there, her coronary vasculature shows no critical lesions. A left ventriculogram during systole is shown below.

Challenge: This is the favorite Moffitt cardiac diagnosis. What are you looking at?

Image shown under fair use.

3 comments:

CodeDog said...

Tako-tsubo cardiomyopathy
The image shows ballooning of the left ventricular.
Along with the absence of obstruction in the coronary artery, the recent emotional distress and the mimicking of ACS symptoms, this is a classic presentation for the disorder.

Alex said...

takotsubo

Craig Chen said...

excellent!
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Octopus

This is takotsubo cardiomyopathy, first described in Japan and named after an octopus trap because of the shape of the left ventricle. It is also called broken heart syndrome and stress-induced cardiomyopathy. It presents with transient apical or midventricular LV dysfunction mimicking MI in the absence of CAD. Takotsubo is triggered by an acute medical illness or emotional or physical stressor. The left ventriculogram shows mid, distal, and apical LV ballooning with vigorous contraction of the basal segment.

Sources: UpToDate; nature.com.