Confirmed by over-reading physician
OMI with Low Confidence
DIffuse ST Elevation with Apical Ballooning: is it Takotsubo Stress Cardiomyopathy?
There is much less evidence of OMI now. I looks as if there has been reperfusion.
PM Cardio AI Bot:
Not OMI with high confidence
Angiogram:
Speckle Tracking of Acute Pulm Edema.MOV from Stephen Smith on Vimeo.
--Mild Plaque no angiographically significant obstructive coronary artery disease.--This is most likely stress induced cardiomyopathy, formal TTE today
2 hour trop = 1871 ng/L
6 hour trop = 2094 ng/L
This is likely to be near the peak
Formal bubble contrast echo:
Normal left ventricular size with moderately reduced systolic function.
The estimated ejection fraction is 38%.
Regional wall motion abnormality-apex, anterior akinesis.
In comparison to the previous study, 11/11/2020, there has been a significant interval deterioration of left ventricular systolic function (previous EF 80%), and there is a new large apical wall motion abnormality.
Stress induced cardiomyopathy (Takotsubo like LV dysfunction) possible.
Here is the next day ECG:
Outcome:
She was diagnosed with stress cardiomyopathy, though it is not entirely classic. The ECG findings are focal to the anterior and high lateral wall. The echo findings were similarly focal to those walls. It is possible that it was a MINOCA instead, possible that it was due to thrombus that lysed, but the management is the same: medical management including aspirin carvedilol, and a statin.
Takotsubo (and Myocarditis) are both frequently impossible to differentiate from acute OMI on ECG, even if augmented by echocardiography and troponins.
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