This post is an answer to the ECG Case 345
- Rate: 78 bpm
- Rhythm: regular sinus rhythm
- Axis: normal
- Intervals:
- PR – Normal (~160ms)
- QRS – Normal (80ms)
- Additional:
- ST elevation in leads V2-5 (~1mm)
- Subtle ST elevation in leads II, III, aVF, V6
- T wave inversion in leads II, III, aVF, V3-6
- Absence of ST depression
- Low voltage P wave with notching in lead II
Differential diagnoses
- ACS
- Demand ischaemia
- Cardiomyopathy – acute vs chronic
- Electrolyte abnormality / Acid-base disturbance
What happened next ?
This patient had no history of chest pain, no pre-existing medical condition and was not significantly unwell from her assumed cholecystitis. Vital signs and electrolytes were normal. She was admitted under the cardiology team for further investigation of ECG abnormalities with surgical consultation for management of cholecystitis.
The patient had raised cardiac biomarkers and underwent angiography. The angiogram showed no coronary vessel disease but Takotsubo pattern cardiomyopathy, EF 35-40%. The patient was commenced on beta-blocker, ACE and diuretic therapy and will undergo an elective cholecystectomy once normal cardiac function returns on follow-up echo.
SIMILAR CASES:
