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Case Reports
. 2018 Apr 5;2(2):158-162.
doi: 10.5811/cpcem.2018.2.37291. eCollection 2018 May.

Takotsubo Cardiomyopathy in the Emergency Department: A FOCUS Heart Breaker

Kristin Meigh  1 , Madison Caja  1 , Melinda Sharon  2 , Allison Tadros  2 , Shane Dragan  2 , David Henkel  2 , Joseph Minardi  2   3
Affiliations
Case Reports

Takotsubo Cardiomyopathy in the Emergency Department: A FOCUS Heart Breaker

Kristin Meigh et al. Clin Pract Cases Emerg Med. .

Abstract

Takotsubo cardiomyopathy (TCM) is an important condition for the emergency physician to consider in patients with cardiovascular symptoms. A 70-year-old woman presented with chest pain and nausea following emotional trauma. She had an elevated troponin and a normal electrocardiogram with no history of previous cardiac disease. Point-of-care focused cardiac ultrasound (FOCUS) showed reduced left ventricular systolic function with mid to apical hypokinesis. Cardiac catheterization revealed clean coronary arteries and confirmed the suspected diagnosis of TCM. Few reports emphasize the importance of FOCUS in the diagnosis and management of TCM in the emergency department. We detail FOCUS findings that assisted with diagnosis of TCM and describe how this quick, noninvasive imaging modality can be used to assess and manage emergent conditions.

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Conflict of interest statement

Conflicts of Interest: By the CPC-EM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. The authors disclosed none.

Figures

Image 1
Image 1
This apical 4-chamber view of the heart performed by the emergency physician demonstrates findings of apical ballooning, with systolic mid to apical hypokinesis of the left ventricle (LV). The basal segments near the atrioventricular septum contract appropriately in systole (solid arrows), but the mid to apical segments of the left ventricle show minimal contraction and demonstrate ballooning when systole is compared to diastole (outlined arrowheads). These findings match the description of the classic apical variant of takotsubo cardiomyopathy, which is said to resemble an octopus pot. LA, left atrium.
Image 2
Image 2
These parasternal long-axis views, both with (panels C and D) and without (panels A and B) color, demonstrate the systolic apical ballooning of the left ventricle (LV) with preserved contraction of the basal segments. The apical portions of the interventricular septum and free wall of the left ventricle do not show significant movement when systole (panels B and D) is compared to diastole (panels A and C), indicating impaired contraction of the apical segment (outlined arrowheads). The left ventricular basal segments, however, move closer together in systole (panels B and D) to show preserved contraction of this portion of the heart (solid arrows).
See this image and copyright information in PMC

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