tag:blogger.com,1999:blog-549949223388475481.post6629936000332861335..comments2024-03-28T14:02:08.119-05:00Comments on Dr. Smith's ECG Blog: Acute chest pain, ST Depression in V2 and V3, relief with Nitroglycerine, "normal" coronaries, and apical ballooning. Is it takotsubo?Unknownnoreply@blogger.comBlogger5125tag:blogger.com,1999:blog-549949223388475481.post-60678226573237084302021-01-30T13:04:35.318-06:002021-01-30T13:04:35.318-06:00It is certainly possible. It is certainly possible. Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-39388180595548401342021-01-16T22:57:38.081-06:002021-01-16T22:57:38.081-06:00Thanks to Dr.Mike Fisher and Steve Smith for a ver...Thanks to Dr.Mike Fisher and Steve Smith for a very interestng case. One question. This patient's chest pain and ecg changes resolved with nitro. Cath shows clean coronaries. So, can this be a case<br />of coronary (LCX) spasm ? I came across similar case reported by Ikuo Misumi et al titled ' CORONARY SPASM AS A CAUSE OF TAKOTSUBO CARDIOMYOPATHY ' in Journal of Cardilology Cases- vol 2, issue 2, oct 2010 page e83-e87. With regards, Dr.R.Balasubramanian. Pondicherry - INDIAdr. R.Balaubramanianhttps://www.blogger.com/profile/10882266041266448279noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-52697167122616690312021-01-12T07:02:57.223-06:002021-01-12T07:02:57.223-06:001. i thought CP with ST depression V2, and or V3 w...1. i thought CP with ST depression V2, and or V3 was an indication for stat cath (possible posterior wall OMI till proven otherwise. altho at a recent Amal Mattu toronto cards course, Amal said he'd get posterior leads to look for ST elevation, and act on that. But i think that in a case like this, i'd feel more comfortable with stat cath (tho not sure what our interventionalists would say.)<br /><br />STD V2/V3 IS INDICATION. THIS CASE ILLUSTRATES THAT SOMETIMES IT MAY BE FALSE POSITIVE (ALTHOUGH THIS ONE IS NOT NECESSARILY A FALSE POSITIVE). WE JUST SUBMITTED AN ABSTRACT SHOWING THAT STD MAX IN V2-V4 IS POSTERIOR MI 85% OF THE TIME. ABSENCE OF STE IN POSTERIOR LEADS SHOULD NOT DISSUADE YOU FROM THE DIAGNOSIS. I THINK AMAL IS WRONG ABOUT THAT AND HE DOES NOT HAVE DATA TO SUPPORT IT.<br /><br />2. funny: i also thought IVUS would be nice, but not even sure where they do that in northern california. YES, SHOULD USE IVUS<br /><br />3. above: "D-dimer was sent as further rule out for dissection." although the dimer is interesting i thought it certainly does not rule out dissection, as does not the bedside US.<br />(just had a 34 y old chest /abdominal pain BP 270/140, i did a stat bedside US , including over the sternal notch, saw no obvious pathology. but the CT chest/abd/pelvis in the next few minutes showed a dissection stanford type A to the iliacs, which may be a poor reflection on my US expertise perhaps). WE DID NOT STATE THAT IT RULED OUT DISSECTION, JUST THAT IT WAS NEGATIVE. IT DOES HAVE SOME USE AND MICHAEL USED IT. <br /><br />4. wouldn't apical ballooning have inferior wall changes? the site of the ischemia? or not necessarily? APICAL BALLOONING IS MOTION ABNORMALITY OF ALL WALLS, INCLUDING INFERIOR. IF IT FULLY MANIFESTS ON THE ECG, YOU WOULD SEE ECG CHANGES OF ALL WALLS. THIS IS ONE REASON WHY I THINK TAKOTSUBO IS NOT THE CORRECT DIAGNOSIS<br /><br />5. why discharged on ace-inhibitor and beta-blocker, if her coronaries are "clean"; is this the treatment for takotsubo (which means "octopus trap" in japanese)? I DON'T KNOW WHAT THE THINKING WAS, BUT WE OBVIOUSLY DID NOT PRESENT ALL THE MEDICAL HISTORY OR THINKING HERE.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-29633057590822603152021-01-12T04:52:19.957-06:002021-01-12T04:52:19.957-06:00Thank you so very much Mike Fischer, and Steve.
th...Thank you so very much Mike Fischer, and Steve.<br />this case interests me... questions, and certainly not criticisms:<br />1. i thought CP with ST depression V2, and or V3 was an indication for stat cath (possible posterior wall OMI till proven otherwise. altho at a recent Amal Mattu toronto cards course, Amal said he'd get posterior leads to look for ST elevation, and act on that. But i think that in a case like this, i'd feel more comfortable with stat cath (tho not sure what our interventionalists would say.)<br /><br />2. funny: i also thought IVUS would be nice, but not even sure where they do that in northern california.<br /> <br />3. above: "D-dimer was sent as further rule out for dissection." although the dimer is interesting i thought it certainly does not rule out dissection, as does not the bedside US.<br />(just had a 34 y old chest /abdominal pain BP 270/140, i did a stat bedside US , including over the sternal notch, saw no obvious pathology. but the CT chest/abd/pelvis in the next few minutes showed a dissection stanford type A to the iliacs, which may be a poor reflection on my US expertise perhaps).<br /><br />4. wouldn't apical ballooning have inferior wall changes? the site of the ischemia? or not necessarily?<br /><br />5. why discharged on ace-inhibitor and beta-blocker, if her coronaries are "clean"; is this the treatment for takotsubo (which means "octopus trap" in japanese)?<br /><br />Michael, extraordinary, illustrative and problematic case. thank you for this detailed blog.<br />very cool discussion. thank you, steve.tfierohttps://www.blogger.com/profile/15955268501222734373noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-63421477944407680832021-01-08T11:00:10.935-06:002021-01-08T11:00:10.935-06:00nice case.nice case.Anonymoushttps://www.blogger.com/profile/12693786314434472693noreply@blogger.com