74-year-old male with type 2 diabetes, CAD s/p stent 6 years prior, hypertension and hypercholesterolemia, fell at home and presents to the ER.
A CXR performed 4 years before, showed no acute cardiopulmonary disease. Healed right sided rib fractures and healed right clavicular fracture were of incidental note
Location 3
TAKOTSUBO CARDIOMYOPATHY A CXR performed 4 years before, shows no acute cardiopulmonary disease. Healed right sided rib fractures and healed right clavicular fracture were of incidental note Ashley Davidoff MD
In the ER a non-displaced right hip fracture was identified and uncomplicated hemiarthroplasty was performed.
Location 3
ACUTE HIP FRACTURE HEMIARTHROPLASTY In the ER a non-displaced right hip fracture was identified and uncomplicated hemiarthroplasty was performed. Ashley Davidoff MD
CXR at the time showed no acute disease
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TAKOTSUBO CARDIOMYOPATHY CXR at the time shows no acute disease Ashley Davidoff MD
He was discharged and in the interim prior to readmission 2 weeks later his wife fell and had to be admitted to the hospital.
At the time of his next readmission he presented in shock. (NYHA Class IV and ASA Class 4)
CXR showed pulmonary edema.
LA? Difficult to see
Fuzzy Vessels Perihilar Infiltrates
10, 20 or 30?
Wedge pressure >30
Location 3
ACUTE CHF At the time of his next readmission he presented in shock. (NYHA Class IV and ASA Class 4) CXR showed pulmonary edema. EKG showed new LBB Ashley Davidoff MD
EKG showed new LBB
Echo at the bedside in the ICU showed an ejection fraction of 15%, with global hypokinesis sparing the base of the heart. There was moderate MR, PAP 44-65mm Hg, RV was normal.
Preliminary diagnosis of an acute MI was made with acute systolic heart failure and cardiogenic shock
He was transferred to the Cath Lab
Prior to gaining access to the arterial system the patient went into PEA requiring sustained CPR requiring both epinephrine, atropine and urgent intubation
Emergent cardiac catheterization showed an LV pressure of 64/17 and wedge pressure of 41 mmHg. Temporary pacemaker was placed as well as an IABP. No significant CAD was identified.
AP PROJECTION Which is the LAD? Look for the septal perforators running to the diaphragm
Location 3
TAKOTSUBO CARDIOMYOPATHY LCA in A-P shows NO SIGNIFICANT STENOSES Ashley Davidoff MD
LAD – Now there are some beautiful perforators off the LAD supplying 2/3 of the septum
Location 3
TAKOTSUBO CARDIOMYOPATHY LCA in RAO shows NO SIGNIFICANT STENOSES No significant CAD was identified. Ashley Davidoff MD
RCA – SA nodal of RCA (40%) Early Take of of the PDA , RCA Dominant (85%)
Location 3
TAKOTSUBO CARDIOMYOPATHY RCA in LAO show NO SIGNIFICANT STENOSES Ashley Davidoff MD
