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Electrocardiographic abnormalities of takotsubo cardiomyopathy in a patient with paced ventricular rhythm.

Chauhan K, Sontineni SP, Alla VM, Holmberg MJ - Cardiol Res Pract (2010)

Bottom Line: Classic ECG changes of TCM include ST elevation or T wave inversion.Herein, we report the case of an 85-year-old pacemaker dependant female who was diagnosed with TCM four weeks following the demise of her husband.Abnormal negative T wave concordance in precordial leads and QT interval prolongation were the only new ECG findings and these reverted back to baseline on followup.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Creighton University, Omaha, NE 68178, USA.

ABSTRACT
Takotsubo cardiomyopathy (TCM) is a unique cardiomyopathy characterized by chest pain, ECG, and regional wall motion abnormalities closely mimicking acute myocardial infarction, in the absence of significant coronary artery disease. Classic ECG changes of TCM include ST elevation or T wave inversion. However, ECG abnormalities of TCM in patients with paced ventricular rhythms have not been well characterized. Herein, we report the case of an 85-year-old pacemaker dependant female who was diagnosed with TCM four weeks following the demise of her husband. Abnormal negative T wave concordance in precordial leads and QT interval prolongation were the only new ECG findings and these reverted back to baseline on followup.

No MeSH data available.


Related in: MedlinePlus

Baseline ECG (two months prior to presentation): ventricular-paced rhythm at the rate of 70, corrected QT interval (QTc) of 410 milliseconds (msec).
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fig2: Baseline ECG (two months prior to presentation): ventricular-paced rhythm at the rate of 70, corrected QT interval (QTc) of 410 milliseconds (msec).

Mentions: An 85-year-old female presented to the emergency department with moderately severe retrosternal chest pain of 2-hour duration, 4 weeks after the demise of her husband. Pain was associated with lightheadedness, nausea, and one episode of vomiting. Medical history was significant for hypertension, diabetes mellitus, hypothyroidism, and chronic atrial fibrillation. Due to difficulty in the control of ventricular rates, she underwent atrioventricular node ablation followed by placement of a permanent pacemaker (VVIR mode) two years previously. Her medications included aspirin, atorvastatin, levothyroxine, metoprolol succinate, metformin, and dabigatran (factor Xa inhibitor — recruited as part of a research trial). On examination, blood pressure was 180/70 mmHg, heart rate: 70/min, and respirations were 18/minute. Cardiovascular examination was significant for grade 3/6 systolic murmur at apex and lung fields were clear to auscultation. ECG on admission (Figure 1) showed ventricular-paced rhythm with negatively concordant T wave inversions in left precordial leads and QTc of 510 msec. There was a non-significant increase in discordant ST segment elevation in V2-V3 compared to baseline ECG. Her baseline ECG (2 months prior) showed a QTc of 410 msec and normal discordant T waves in precordial leads (Figure 2). A presumptive diagnosis of unstable angina was made. Blood cell count and metabolic panel were normal and troponin was borderline elevated. Echocardiogram showed an ejection fraction (EF) of 35–40% with severe apical hypokinesis and mild mitral regurgitation. There was no evidence of left ventricular outflow tract obstruction. Echocardiogram done three months prior had shown an EF of 55–60% without regional wall motion abnormalities. Emergent cardiac catheterization revealed nonobstructive coronary artery disease and ventriculogram revealed akinetic apex with normal basal segment motion, consistent with TCM. She was started on lasix and lisinopril; betablocker, oral anticoagulation, and other home medications were resumed. On follow up a month later, she was asymptomatic, and repeat echocardiogram showed an EF of 60–65% with resolution of regional wall motion abnormalities. ECG returned to baseline with normal discordant T waves in precordial leads and a QTc of 430 msec.


Electrocardiographic abnormalities of takotsubo cardiomyopathy in a patient with paced ventricular rhythm.

Chauhan K, Sontineni SP, Alla VM, Holmberg MJ - Cardiol Res Pract (2010)

Baseline ECG (two months prior to presentation): ventricular-paced rhythm at the rate of 70, corrected QT interval (QTc) of 410 milliseconds (msec).
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2902051&req=5

fig2: Baseline ECG (two months prior to presentation): ventricular-paced rhythm at the rate of 70, corrected QT interval (QTc) of 410 milliseconds (msec).
Mentions: An 85-year-old female presented to the emergency department with moderately severe retrosternal chest pain of 2-hour duration, 4 weeks after the demise of her husband. Pain was associated with lightheadedness, nausea, and one episode of vomiting. Medical history was significant for hypertension, diabetes mellitus, hypothyroidism, and chronic atrial fibrillation. Due to difficulty in the control of ventricular rates, she underwent atrioventricular node ablation followed by placement of a permanent pacemaker (VVIR mode) two years previously. Her medications included aspirin, atorvastatin, levothyroxine, metoprolol succinate, metformin, and dabigatran (factor Xa inhibitor — recruited as part of a research trial). On examination, blood pressure was 180/70 mmHg, heart rate: 70/min, and respirations were 18/minute. Cardiovascular examination was significant for grade 3/6 systolic murmur at apex and lung fields were clear to auscultation. ECG on admission (Figure 1) showed ventricular-paced rhythm with negatively concordant T wave inversions in left precordial leads and QTc of 510 msec. There was a non-significant increase in discordant ST segment elevation in V2-V3 compared to baseline ECG. Her baseline ECG (2 months prior) showed a QTc of 410 msec and normal discordant T waves in precordial leads (Figure 2). A presumptive diagnosis of unstable angina was made. Blood cell count and metabolic panel were normal and troponin was borderline elevated. Echocardiogram showed an ejection fraction (EF) of 35–40% with severe apical hypokinesis and mild mitral regurgitation. There was no evidence of left ventricular outflow tract obstruction. Echocardiogram done three months prior had shown an EF of 55–60% without regional wall motion abnormalities. Emergent cardiac catheterization revealed nonobstructive coronary artery disease and ventriculogram revealed akinetic apex with normal basal segment motion, consistent with TCM. She was started on lasix and lisinopril; betablocker, oral anticoagulation, and other home medications were resumed. On follow up a month later, she was asymptomatic, and repeat echocardiogram showed an EF of 60–65% with resolution of regional wall motion abnormalities. ECG returned to baseline with normal discordant T waves in precordial leads and a QTc of 430 msec.

Bottom Line: Classic ECG changes of TCM include ST elevation or T wave inversion.Herein, we report the case of an 85-year-old pacemaker dependant female who was diagnosed with TCM four weeks following the demise of her husband.Abnormal negative T wave concordance in precordial leads and QT interval prolongation were the only new ECG findings and these reverted back to baseline on followup.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Creighton University, Omaha, NE 68178, USA.

ABSTRACT
Takotsubo cardiomyopathy (TCM) is a unique cardiomyopathy characterized by chest pain, ECG, and regional wall motion abnormalities closely mimicking acute myocardial infarction, in the absence of significant coronary artery disease. Classic ECG changes of TCM include ST elevation or T wave inversion. However, ECG abnormalities of TCM in patients with paced ventricular rhythms have not been well characterized. Herein, we report the case of an 85-year-old pacemaker dependant female who was diagnosed with TCM four weeks following the demise of her husband. Abnormal negative T wave concordance in precordial leads and QT interval prolongation were the only new ECG findings and these reverted back to baseline on followup.

No MeSH data available.


Related in: MedlinePlus