Cath Lab Digest - January 2008 - (Page 24)

24 CLINICAL UPDATE JANUARY 2008 Takotsubo Cardiomyopathy, a.k.a., Transient Left Ventricular Apical Ballooning Syndrome: An Acute Coronary Syndrome Imposter Brenda McCulloch, RN, MSN, CNS Cardiovascular Clinical Nurse Specialist Cardiac Catheterization Laboratory, Sutter Heart Institute Sutter Medical Center, Sacramento, California Case Study A 66-year-old female presented to the ED complaining of 8/10 retrosternal chest pain and dyspnea. She was triaged quickly and her initial ECG, done within minutes of arrival, showed possible lateral infarct, T wave inversion in the precordial leads, and QT prolongation. She was given chewable aspirin 325mg and started on eptifibatide (Integrilin). Her first troponin was elevated at 3.35 ng/mL. She had no significant medical history. She was the primary caregiver for her husband with severe Alzheimer’s disease. She was diagnosed with acute myocardial infarction and referred to cardiology for additional evaluation. She was taken to the cardiac cath lab for cardiac catheterization and possible coronary intervention. Interestingly, her coronary arteries were normal with no signs of atherosclerotic plaque (Figure 1, 2). Methergine testing was done and ruled out coronary artery spasm. The left ventriculogram was markedly abnormal, however, demonstrating significant anteroapical wall motion abnormalities. Marked systolic dyskinetic ballooning of the apex was noted (Figure 3). The LVEDP was 29 mmHg and the ejection fraction was estimated to be 40–45%. Based on these findings, the patient’s diagnosis was revised to Takotsubo cardiomyopathy. The eptifibatide infusion was discontinued and she was transferred to the cath lab holding area. The 6 Fr femoral arterial sheath was removed and hemostasis was achieved. The patient was then transferred to the telemetry unit for continued nursing care. She remained stable and her remaining hospital course was uneventful. Her ECG on the day of discharge showed normal sinus rhythm with giant T wave inversion in leads V3-V6, and her QT continued to be prolonged at Figure 2. Right coronary artery Figure 3. Left ventriculogram in systole Figure 1. Left coronary artery 605 ms (QTc 657 ms, Figure 4). She was discharged home on day 2 with the diagnosis of Takotsubo cardiomyopathy. Discharge medications included enteric coated aspirin 325 mg daily, Lisinopril 2.5 mg daily, Metoprolol 50 mg daily. She was instructed to see her primary care physician in one week and to follow up with cardiology in four weeks for trans-thoracic echocardiography. Introduction Takotsubo cardiomyopathy, also currently referred to in the medical literature as transient left ventricular apical ballooning, broken-heart cardiomyopathy, or stress-induced cardiomyopathy, is an interesting and infrequently seen phenomenon. It is thought to account for about 2% of all acute myocardial infarction presentations.1 It was originally described by the Japanese in the early 1990’s and named after the takotsubo pot, a narrow-necked, bulging pot used by Japanese fishermen to catch octopus,2 a shape they felt described the appearance of the ballooning left ventricle. This syndrome has been reported in both genders, but it is much more common in post-menopausal women.1 Most of these women have experienced a significant psychological or physical stressor that precipitates the onset of their symptoms. The reason for this gender difference is not clear. Sex hormones may play a role in the propensity for ballooning of the left ventricle in females. Patient Presentation Presenting symptoms reported in

Table of Contents Feed for the Digital Edition of Cath Lab Digest - January 2008

Cath Lab Digest - January 2008 Central Baptist Hospital Contrast Media Use in High-Risk Patients An Ergonomic Survey of Cath Lab Repetitive Stress Injuries Contents Clinical Editor’s Corner Takotsubo Cardiomyopathy, a.k.a., Transient Left Ventricular Apical Ballooning Syndrome: An Acute Coronary Syndrome Imposter Searching for the Key to D2B STEMI Intervention News STEMI Interventions: Commentary The Massachusetts Stent Study The Value of Educating Staff Ask the Clinical Instructor: A Q&A Column for Those New to the Cath Lab SICP* Chapter Updates The Society of Invasive Cardiovascular Professionals Holds an RCIS Review Course at New Cardiovascular Horizons 18:20 To Denver — One Student’s First Clinical Experience CEU Education Center Meetings Calendar What Do You Think? Clinical & Industry News Classifieds The Ten-Minute Interview with…Heather Vardon, RN Advertisers Index

Cath Lab Digest - January 2008

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