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Pericarditis in takotsubo cardiomyopathy: a case report and review of the literature.

Kim J, Laird-Fick HS, Alsara O, Gourineni V, Abela GS - Case Rep Cardiol (2013)

Bottom Line: Follow-up EKG in 2 days showed decreased ST-segment elevations in precordial leads.Acute pericarditis can be associated either as a consequence of or as a triggering factor for Takotsubo cardiomyopathy.It is vital for physicians to be aware of pericarditis as a potential complication of Takotsubo cardiomyopathy.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Michigan State University, East Lansing, MI 48824, USA.

ABSTRACT
Case. A 64-year-old Caucasian woman was brought to the emergency department with severe dysphagia and left chest pain for last 4 days. Initial evaluation revealed elevated ST segment in precordial leads on EKG with elevated cardiac enzymes. Limited echocardiogram showed infra-apical wall hypokinesia. Cardiac angiography was done subsequently which showed nonflow limiting mild coronary artery disease. Takotsubo cardiomyopathy was diagnosed and she was treated medically. On the third day of admission, a repeat ECG showed diffuse convex ST-segment elevations in precordial leads, compatible with acute pericarditis pattern of EKG. Decision was made to start colchicine empirically for possible pericarditis. Follow-up EKG in 2 days showed decreased ST-segment elevations in precordial leads. The patient was discharged with colchicine and a follow-up echocardiogram in 4 weeks demonstrated a normal ejection fraction with no evidence of pericarditis. Conclusion. Acute pericarditis can be associated either as a consequence of or as a triggering factor for Takotsubo cardiomyopathy. It is vital for physicians to be aware of pericarditis as a potential complication of Takotsubo cardiomyopathy.

No MeSH data available.


Related in: MedlinePlus

Initial ECG on presentation showing ST-segment elevation in leads V2 to V4, II, III, and aVF.
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fig1: Initial ECG on presentation showing ST-segment elevation in leads V2 to V4, II, III, and aVF.

Mentions: The initial electrocardiogram (ECG) revealed a normal sinus rhythm and ST-segment elevation in leads V2 to V4, II, III, and aVF (Figure 1). The bedside echocardiogram showed anterior wall hypokinesis. Her initial laboratory work-up reported a WBC count of 26000, and urine analysis showed a urinary tract infection. The first set of cardiac enzyme tests was positive with a troponin level of 23.61 ng/mL (normal range <0.02), CPK of 1092 U/L (normal range <155 U/L), and CK-MB fraction total value of 41.5 ng/mL (normal range <6.3 ng/mL). She was given aspirin, nitroglycerin, and a beta-blocker and her chest pain diminished. The patient was immediately transferred to the cardiac catheterization laboratory for primary coronary intervention of a possible ST-elevation myocardial infarction (STEMI). Cardiac angiography demonstrated a proximal 30% nonobstructive tubular stenosis of the right coronary artery, but otherwise normal coronary arteries (Figure 2(a)). Anteroapical and infra-apical wall hypokinesis with an ejection fraction of 20% was noted on repeat echocardiogram (Figure 2(b)). Takotsubo cardiomyopathy was diagnosed based on the clinical presentation and coronary angiographic findings. The beta-blocker and low-dose aspirin were continued.


Pericarditis in takotsubo cardiomyopathy: a case report and review of the literature.

Kim J, Laird-Fick HS, Alsara O, Gourineni V, Abela GS - Case Rep Cardiol (2013)

Initial ECG on presentation showing ST-segment elevation in leads V2 to V4, II, III, and aVF.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4008403&req=5

fig1: Initial ECG on presentation showing ST-segment elevation in leads V2 to V4, II, III, and aVF.
Mentions: The initial electrocardiogram (ECG) revealed a normal sinus rhythm and ST-segment elevation in leads V2 to V4, II, III, and aVF (Figure 1). The bedside echocardiogram showed anterior wall hypokinesis. Her initial laboratory work-up reported a WBC count of 26000, and urine analysis showed a urinary tract infection. The first set of cardiac enzyme tests was positive with a troponin level of 23.61 ng/mL (normal range <0.02), CPK of 1092 U/L (normal range <155 U/L), and CK-MB fraction total value of 41.5 ng/mL (normal range <6.3 ng/mL). She was given aspirin, nitroglycerin, and a beta-blocker and her chest pain diminished. The patient was immediately transferred to the cardiac catheterization laboratory for primary coronary intervention of a possible ST-elevation myocardial infarction (STEMI). Cardiac angiography demonstrated a proximal 30% nonobstructive tubular stenosis of the right coronary artery, but otherwise normal coronary arteries (Figure 2(a)). Anteroapical and infra-apical wall hypokinesis with an ejection fraction of 20% was noted on repeat echocardiogram (Figure 2(b)). Takotsubo cardiomyopathy was diagnosed based on the clinical presentation and coronary angiographic findings. The beta-blocker and low-dose aspirin were continued.

Bottom Line: Follow-up EKG in 2 days showed decreased ST-segment elevations in precordial leads.Acute pericarditis can be associated either as a consequence of or as a triggering factor for Takotsubo cardiomyopathy.It is vital for physicians to be aware of pericarditis as a potential complication of Takotsubo cardiomyopathy.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Michigan State University, East Lansing, MI 48824, USA.

ABSTRACT
Case. A 64-year-old Caucasian woman was brought to the emergency department with severe dysphagia and left chest pain for last 4 days. Initial evaluation revealed elevated ST segment in precordial leads on EKG with elevated cardiac enzymes. Limited echocardiogram showed infra-apical wall hypokinesia. Cardiac angiography was done subsequently which showed nonflow limiting mild coronary artery disease. Takotsubo cardiomyopathy was diagnosed and she was treated medically. On the third day of admission, a repeat ECG showed diffuse convex ST-segment elevations in precordial leads, compatible with acute pericarditis pattern of EKG. Decision was made to start colchicine empirically for possible pericarditis. Follow-up EKG in 2 days showed decreased ST-segment elevations in precordial leads. The patient was discharged with colchicine and a follow-up echocardiogram in 4 weeks demonstrated a normal ejection fraction with no evidence of pericarditis. Conclusion. Acute pericarditis can be associated either as a consequence of or as a triggering factor for Takotsubo cardiomyopathy. It is vital for physicians to be aware of pericarditis as a potential complication of Takotsubo cardiomyopathy.

No MeSH data available.


Related in: MedlinePlus