Tako Tsubo cardiomyopathy
added by Emmel
Tako Tsubo cardiomyopathy
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Added: 01-03-2012
Runtime: 0m 11s
Views: 5689
Comments: 4 Current Rating:
(3 Votes)
Runtime: 0m 11s
Views: 5689
Comments: 4 Current Rating:
(3 Votes)
Description
about 50 y old patient with severe posttraumatic stress disorder caused by death of near relative. The patient was admitted to out ER/ ICU with distinct and typical clinical affliction of acute coronary syndrome. Troponine I 0,8 (normal till 0,023), CK 210 U/l. In ECG we could see repolarisation disturbance without signs of ST-elevations. In TTE you can see myocardial movent disorder of apical LV-wall like an apical ballooning. No disturbance of RV. No US-B-lines, no pleural effusion, no sign of LVOTO despite the echocardiographic picture of hyperdynamic basal LV-wall-segments. In cardiac catheter no sign of coronary disease; we could see in cardiac catheter the typical movement disorder of Tako-Tsubo-CM as we could see in TTE before. One question to the community: Is there ALWAYS a need for cardiac catheter if we see the typical echocardiographic picture of apical ballooning/ Tako-Tsubo-CM?
about 50 y old patient with severe posttraumatic stress disorder caused by death of near relative. The patient was admitted to out ER/ ICU with distinct and typical clinical affliction of acute coronary syndrome. Troponine I 0,8 (normal till 0,023), CK 210 U/l. In ECG we could see repolarisation disturbance without signs of ST-elevations. In TTE you can see myocardial movent disorder of apical LV-wall like an apical ballooning. No disturbance of RV. No US-B-lines, no pleural effusion, no sign of LVOTO despite the echocardiographic picture of hyperdynamic basal LV-wall-segments. In cardiac catheter no sign of coronary disease; we could see in cardiac catheter the typical movement disorder of Tako-Tsubo-CM as we could see in TTE before. One question to the community: Is there ALWAYS a need for cardiac catheter if we see the typical echocardiographic picture of apical ballooning/ Tako-Tsubo-CM?
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Hello my friends. In my short experience I didn´t see tako tsubo by
/>http://123sonography.com/cases/0112_surviving_christmas.html/>
echo to moment...but, when you read literature all tako-tsubo
confirmation are an exclusion diagnosis because of negative coronary
angiogram...
Other point is that coronary anatomy is not fixed,
have a lot of variants...so, in my opinion, tako-tsubo still is a
diagnosis of exclusion...
Of course, is good to think in it and
is better Tako-tsubo in place of coronary involvement...but don´t buy
the diagnosis of tako-tsubo so easy!
I let you another similar
point of view...
Best
Pablo
...If there was a typical echocardiographic picture of Tako-Tsubo WITH
RV-disturbance, I think I did not do the cardia catheter, because that
did not match to coronary circulation at all. My chiefs of cardiology
think that there is always a NEED for cardiac catheter in such cases,
but I don´t know, whether it is the right course of action. Actually
I have to admit that I don´t have a good approach for that cases for
myself. It is very helpful to know, that you have another point of
view and wouldn´t do a catheter in that kind of clinical cases. In my
literature (cardiology journals) I haven´t found an imperative need
for cardiac catheter, but almost all of that recommend a coronary
study. Do you know some papers, that recommend a reserved course of
action in that cases? Once more thank for comment!!! Criticism is
always welcome; that helps me to improve my clinical decision!! I
wonder why no one else of that community have an opinion about that
very interesting question. This is a case almost everybody of us who
use echocardiography in clinical setting is confrontated/ faced with.
So what is the rest of the community doing in that clinical cases?
Best wishes and greetings, Diego!! Jörg.
(Unfortunately I have
to answer you in two parts, because my browser doesn´t accept my
comment in that length).
Hi Diego! Thanks a lot for comment! The Troponin is in that case
positive (we use a very sensitive Troponin-I-test; cutt-off is 0,023;
high-sensitive Troponin was about 90; cutt-off of that test is 30).
You are right, that this values are not very elevated. The clinical
history of the death of a close relative, the clinical afflictions and
echocardiographic picture of apical bollooning is typical for
Tako-Tsubo-CM. But the patient has some coronary risk factors:
condition after smoking, arterial hypertension, hyperlipoproteinaemia
and positive familiy history of coronary disease. So I was in the
dilemma and very doubtful... Retrospective cardia catheter was the
wrong decision (Damn!). ...
HI JORG I HAVE A QUESTION : WHY DID YOU PERFORM A CORONARIC
ANGIOGRAPHY?
Troponin was within the normal values ,
echocardiogram was all in all not so dramatic , the story
Was
typical for a takotsubo , I don't really see the tight need for a
coronaric study....please I am not
Criticizing you but I am
trying to see the whole story from a litlle bit different point of
view .
Maybe did the patient experience a strong an long lasting
heavy chest pain ??? REMEMBER I AM NOT
A CARDIOLOGIST
NICE
CLIP THO' THANKS FOR PUTTING IT UP