Utility of recognizing early electrocardiogram changes in bronchogenic Takotsubo cardiomyopathy: A case report
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摘要
BACKGROUND Takotsubo cardiomyopathy(TCM) is a transient reversible systolic dysfunction,estimated to be the culprit in 1%-2% of patients presenting with clinical symptoms of acute coronary syndrome(ACS). TCM was previously thought to be indistinguishable from ACS on the basis of electrocardiogram(EKG) findings;many authors now describe specific EKG changes that distinguish TCM from ACS as well as aid in early recognition of TCM.CASE SUMMARY This unique case presentation illustrates an uncommon subtype of TCM, and very clearly exemplifies the specific EKG changes meant to aid in distinguishing TCM from ACS. A bronchogenic subtype of TCM has been proposed, given its prevalence and distinguishing features from TCM without pulmonary pathology;this case exemplifies that notion. The specific EKG changes of low QRS voltage and attenuation of the amplitude of the QRS complex are now being noted in the EKGs of TCM patients. This patient presented for worsening shortness of breath and increased productive cough; her EKG revealed ST elevations in leads V3-V6,and low voltage QRS complexes when compared to previous EKG from 12 wk ago; troponin peaked at 5.16 ng/mL. Left heart catheterization did not reveal significant lesions and left ventriculogram findings were consistent with TCM.Patient was treated for COPD exacerbation, her symptoms improved significantly; she was sent home on the appropriate medications.CONCLUSION This case exemplifies EKG changes noted in TCM patients who may aid in early detection and appropriate treatment of TCM.
BACKGROUND Takotsubo cardiomyopathy(TCM) is a transient reversible systolic dysfunction,estimated to be the culprit in 1%-2% of patients presenting with clinical symptoms of acute coronary syndrome(ACS). TCM was previously thought to be indistinguishable from ACS on the basis of electrocardiogram(EKG) findings;many authors now describe specific EKG changes that distinguish TCM from ACS as well as aid in early recognition of TCM.CASE SUMMARY This unique case presentation illustrates an uncommon subtype of TCM, and very clearly exemplifies the specific EKG changes meant to aid in distinguishing TCM from ACS. A bronchogenic subtype of TCM has been proposed, given its prevalence and distinguishing features from TCM without pulmonary pathology;this case exemplifies that notion. The specific EKG changes of low QRS voltage and attenuation of the amplitude of the QRS complex are now being noted in the EKGs of TCM patients. This patient presented for worsening shortness of breath and increased productive cough; her EKG revealed ST elevations in leads V3-V6,and low voltage QRS complexes when compared to previous EKG from 12 wk ago; troponin peaked at 5.16 ng/mL. Left heart catheterization did not reveal significant lesions and left ventriculogram findings were consistent with TCM.Patient was treated for COPD exacerbation, her symptoms improved significantly; she was sent home on the appropriate medications.CONCLUSION This case exemplifies EKG changes noted in TCM patients who may aid in early detection and appropriate treatment of TCM.
BACKGROUND Takotsubo cardiomyopathy(TCM) is a transient reversible systolic dysfunction,estimated to be the culprit in 1%-2% of patients presenting with clinical symptoms of acute coronary syndrome(ACS). TCM was previously thought to be indistinguishable from ACS on the basis of electrocardiogram(EKG) findings;many authors now describe specific EKG changes that distinguish TCM from ACS as well as aid in early recognition of TCM.CASE SUMMARY This unique case presentation illustrates an uncommon subtype of TCM, and very clearly exemplifies the specific EKG changes meant to aid in distinguishing TCM from ACS. A bronchogenic subtype of TCM has been proposed, given its prevalence and distinguishing features from TCM without pulmonary pathology;this case exemplifies that notion. The specific EKG changes of low QRS voltage and attenuation of the amplitude of the QRS complex are now being noted in the EKGs of TCM patients. This patient presented for worsening shortness of breath and increased productive cough; her EKG revealed ST elevations in leads V3-V6,and low voltage QRS complexes when compared to previous EKG from 12 wk ago; troponin peaked at 5.16 ng/mL. Left heart catheterization did not reveal significant lesions and left ventriculogram findings were consistent with TCM.Patient was treated for COPD exacerbation, her symptoms improved significantly; she was sent home on the appropriate medications.CONCLUSION This case exemplifies EKG changes noted in TCM patients who may aid in early detection and appropriate treatment of TCM.
引文
1 Demirelli S,Ermis E,Hatem E,Uslu A,Askin L.Focal mid-ventricular anterior ballooning:An unusual pattern of Takotsubo cardiomyopathy.Intractable Rare Dis Res 2015;4:108-110[PMID:25984431 DOI:10.5582/irdr.2015.01012]
2 Madhavan M,Prasad A.Proposed Mayo Clinic criteria for the diagnosis of Tako-Tsubo cardiomyopathy and long-term prognosis.Herz 2010;35:240-243[PMID:20582391 DOI:10.1007/s00059-010-3339-x]
3 Rajwani A,Adam Z,Hall JA.Bronchogenic stress cardiomyopathy:a case series.Cardiology 2015;130:106-111[PMID:25612607 DOI:10.1159/000369296]
4 Katsa I,Christia P,Massera D,Faillace R.Recurrent Stress Cardiomyopathy During COPD Exacerbation:Are Beta-adrenergic Agonists Only to Blame?Cureus 2017;9:e1166[PMID:28507838 DOI:10.7759/cureus.1166]
5 Manfredini R,Fabbian F,Giorgi AD,Pala M,Menegatti AM,Parisi C,Misurati E,Tiseo R,Gallerani M,Salmi R,Bossone E.Heart and lung,a dangerous liaison-Tako-tsubo cardiomyopathy and respiratory diseases:A systematic review.World J Cardiol 2014;6:338-344[PMID:24944763 DOI:10.4330/wjc.v6.i5.338]
6 Hertting K,Krause K,H?rle T,Boczor S,Reimers J,Kuck KH.Transient left ventricular apical ballooning in a community hospital in Germany.Int J Cardiol 2006;112:282-288[PMID:16325287 DOI:10.1016/j.ijcard.2005.09.006]
7 Madias JE.Transient attenuation of the amplitude of the QRS complexes in the diagnosis of Takotsubo syndrome.Eur Heart J Acute Cardiovasc Care 2014;3:28-36[PMID:24562801 DOI:10.1177/2048872613504311]
2 Madhavan M,Prasad A.Proposed Mayo Clinic criteria for the diagnosis of Tako-Tsubo cardiomyopathy and long-term prognosis.Herz 2010;35:240-243[PMID:20582391 DOI:10.1007/s00059-010-3339-x]
3 Rajwani A,Adam Z,Hall JA.Bronchogenic stress cardiomyopathy:a case series.Cardiology 2015;130:106-111[PMID:25612607 DOI:10.1159/000369296]
4 Katsa I,Christia P,Massera D,Faillace R.Recurrent Stress Cardiomyopathy During COPD Exacerbation:Are Beta-adrenergic Agonists Only to Blame?Cureus 2017;9:e1166[PMID:28507838 DOI:10.7759/cureus.1166]
5 Manfredini R,Fabbian F,Giorgi AD,Pala M,Menegatti AM,Parisi C,Misurati E,Tiseo R,Gallerani M,Salmi R,Bossone E.Heart and lung,a dangerous liaison-Tako-tsubo cardiomyopathy and respiratory diseases:A systematic review.World J Cardiol 2014;6:338-344[PMID:24944763 DOI:10.4330/wjc.v6.i5.338]
6 Hertting K,Krause K,H?rle T,Boczor S,Reimers J,Kuck KH.Transient left ventricular apical ballooning in a community hospital in Germany.Int J Cardiol 2006;112:282-288[PMID:16325287 DOI:10.1016/j.ijcard.2005.09.006]
7 Madias JE.Transient attenuation of the amplitude of the QRS complexes in the diagnosis of Takotsubo syndrome.Eur Heart J Acute Cardiovasc Care 2014;3:28-36[PMID:24562801 DOI:10.1177/2048872613504311]