The Octopus Trap

A 78 y/o woman was admitted to the MICU for hypoxemic respiratory failure and sepsis thought to be secondary to pneumonia. She was intubated and placed on vasopressors. Bedside cardiac ultrasound revealed a hypokinetic apex. Suspicions for stress cardiomyopathy were later supported w/ formal echo. Her hospital course was complicated by ST elevations in the lateral leads concerning for MI and she underwent cardiac catheterization which revealed no significant disease in the circumflex or RCA and 50% stenosis of the mid/proximal LAD.

Takotsubo’s Cardiomyopathy:
-Occurs more often in postmenopausal elderly women
-Characterized by transient LV apex hyokinesis
-Associated w/ emotional or physical stress (pathophysiology is poorly understood)
-Can present w/ ST elevations (precordial ST elevations in 50% of pts), Q waves in the precordial leads
-Can see cardiac enzyme elevations, however they decrease rapidly compared to ACS
-There are several (albeit controversial) diagnostic criteria Mayo Clinic’s includes
1) Suspicion of AMI (chest pain, ST elevations)
2) Transient hypo or akinesia of the middle and apical regions of the LV and functional hyperkinesia of the basal region, observed on ventriculography or echocardiography
3) Normal coronary arteries confirmed by arteriography (luminal narrowing of less than 50% in all coronary arteries)
4) Absence of significant head injury, intracranial hemorrhage, suspicion of pheochromocytoma, myocarditis, or HOCM

References:

Komamura, K., Fukui, M., Iwasaku, T., Hirotani, S. and Masuyama, T. (2014) ‘Takotsubo cardiomyopathy: Pathophysiology, diagnosis and treatment’, 6(7).
In-text citations: (Komamura et al., 2014)

 

-Mark Schaefer, MD

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Stephanie Tseeng
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Stephanie Tseeng
4 years ago

Great case! Fortunately the majority of cases resolve, but studies estimate that up to 5% of women being evaluated for heart attack actually have Takotsubo! Interestingly, the words “Tako-Tsubo” mean “octopus pot” in Japanese for the narrow necked pot that is used to trap octopus.

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