Takotsubo Cardiomyopathy Case Study Paper

Apical hypertrophic cardiomyopathy is a disease that mainly affects the apex of the heart and does not cause any obstruction. [1] These abnormalities in the heart muscle can cause a wide variety of symptoms. As the heart becomes stiff it increases the pressure in the left ventricle which can push blood back into the lungs, causing shortness of breath in exercise. Chest pain can occur as there is not enough oxygen available to the cardiac muscle due to insufficient blood supply. Palpitations and lightheadedness, along with other conditions can occur as a result of HCM. In addition to these discomforting symptoms, the patient may develop an arrhythmias that often goes unnoticed. An arrhythmia takes place as the electrical conduction of the heart is disturbed by the abnormal scattering of myocytes. The two most common arrhythmias are atrial fibrillation causing palpitations, and ventricular tachycardia that can be life threatening causing sudden death. Both conditions can be controlled with medication. [4]

You are working in the internal medicine clinic of a large teaching hospital. Today your first patient is 70-year-old J.M, a man who has been coming to the clinic for several years for management of CAD and HTN. A cardiac catheterization done a year ago showed 50% stenosis of the circumflex coronary artery. He has had episodes of dizziness for the past 6 months and orthostatic hypotension, shoulder discomfort, and decreased exercise tolerance for the past 2 months. On his last clinic visit 3 weeks ago, a CXR showed cardiomegaly and a 12-lead ECG showed sinus tachycardia with left bundle branch block. You review his morning blood work and initial assessment.

Dr. Arantza Manzanal explains how takotsubo was initially described “as a syndrome of reversible LV dysfunction with wall-motion abnormalities that involve the apical and midventricular segments” (57). Dr. Paolo Angelini rationalizes that “only during the last 2 decades have Japanese authors specifically categorized transient takotsubo cardiomyopathy (TTC) as an entity in itself. Before that time, TTC was often called “acute myocardial infarction with normal coronary arteries” (312). We will

HCM happens when the heart muscle enlarges and thickens without an obvious cause. Usually the ventricles, the lower chambers of the heart, and septum thicken. The thickened areas create narrowing or blockages in the ventricles, making it harder for the heart to pump blood; however, in very few instances the heart actually contracts with much greater force causing an obstruction to the blood flow (CMUK, 2015). HCM also can cause stiffness of the ventricles, changes in the mitral valve, and cellular changes in the heart tissue.

Cardiovascular. Client denies chest pain, palpitations, murmurs, any arrhythmias, hypertension, awakening at night with shortness of breath, or dizzy spells. Client has not had an electrocardiogram.

Mr. Heart had coronary artery bypass to four vessels three days ago. His transcutaneous epicardial pacing wires were discontinued in the morning along with the single chest tube he had. He is out of bed in a chair and ambulated 200 feet. His blood pressure is 120/72, heart rate 88 regular in rhythm and without ectopy, respiratory rate 18 and unlabored.

The patient, Meriem Haile has been complaining of chest pains along with many other symptoms. She had cardiac catheterization, coil occlusion of PDA, done at the age of 16, for congenital defect. Now she has been diagnosed with SVT (supraventricular tachycardia), occurring 8% of the time. She complains of headaches that come after any physical activity, such as going up stairs. She used to be able to run cross country, but now stopped doing any exercise due to the recurring headaches. She also complains of experiencing blackout when standing up from a sitting position.

Kussmaul’s sign can be observed due to increased venous pressure. Heart sounds are usually normal, however a third heart sound referred to as S3 may be heard due to rapid ventricular filling. Regurgitation murmurs may also be heard. EKG abnormalities vary depending on the progression of the disease, but are abnormal in more than 90% of cases (Reardon 2017). Abnormalities include a low voltage QRS most often due to an infiltrative disease, atrial arrhythmias and abnormal ST-T waves. Chest radiography shows a normal cardiac profile with cardiomegaly and bi-atrial enlargement. Pleural effusions may be present as

Cardiomyopathy is a type of progressive heart disease in which the heart is abnormally enlarged, thickened, and/or stiffened. As a result, the heart muscle's ability to pump blood is weakened, often causing heart failure and the backup of blood into the lungs in rest of the body. The disease can also cause abnormal heart rhythms. Some say having a big heart is a good thing but only in certain situations.There a 3 types of Cardiomyopathy and they are: Dilated Cardiomyopathy (DCM) is a condition in which the heart becomes enlarged and cannot pump blood efficiently. This disease affects the lungs, liver, and other body systems. Another is Hypertrophic Cardiomyopathy (HCM) is a primary disease of the myocardium, in which a portion of the myocardium

After the H&P test that the provider may want to order are ECG, CXR, troponin, and B-type natriuretic peptide (BNP). These tests are going to help confirm the diagnosis of the acute heart failure due to MI. The treatments that this

Mr S is tachycardic (Awtry, Jeon, & Ware, 2006), which means that there is disruption of the normal electrical impulse. The presence of atrial fibrillation would suggest that the disruption in electrical activity is occurring in the left atrium rather than the sinus node. If the heart rate has been elevated for a prolonged period it could lead to tachycardia induced cardiomyopathy (TIC) which can lead to HF (Patel & Whittaker, 2007). The increase in resting bpm is a compensatory mechanism used to maintain cardiac output when there is a loss in pumping capacity (Watson, Gibbs, & Lip, 2000). The potential diagnosis of heart disease or failure is further evidenced by no palpable apex beat. This displacement of the apex beat usually indicates cardiomegaly; cardiomegaly is a sign that the heart cannot keep up with its workload and so enlarges to compensate (Madhok et al., 2008). This enlarged heart starts to retain fluid, causing the lungs to become congested and can potentially result in the irregular pulse found on investigation (Kruijt & Turin, 2012). This excessive fluid in the airways can also be the cause of inspiratory crackles. If on examination there appeared to be transudate, this can help to add to the clinical suspicion of chronic heart failure. The character of the crackle can also help in diagnosis; a moist late inspiratory crackle suggests restrictive (alveolar)

Dilated cardiomyopathy was first time registered in Heart Muscle Disease Registry in Trieste in 1978 and about 747 patients with DCM enlisted up to 2007 by Aleksova (2009). The systolic ventricular function is impaired is registered in British heart journal (1980). Merlo (2007) described that DCM is a group of different diseases. dilated cardiomyopathy is described as a progressive ventricular wall thinning and dilatation.

Everyone who has a NSTEMI, their signs and symptoms (s/s) can vary. Symptoms are what a patient experiences. Chest discomfort or pain can be felt with most heart attacks. This discomfort is usually “…in the center of the chest that lasts more than a few minutes, or that goes away and comes back. It can feel like uncomfortable chest pressure, squeezing, fullness or pain” (Heart Attack, 2017). Besides the chest, there can be other areas of discomfort. Per AHA from the article Heart Attack in 2017, this pain can radiate to neck, back, jaw, one or both arms/shoulders, or even to the stomach. Another telltale symptom that a patient complains of would be shortness of breath, and this could be with or without pain. What is detected by someone else such as the caregiver are signs. Signs of having a non-ST-elevation MI could include diaphoresis, dizziness, or nausea. Looking further into signs of a NSTEMI would be at diagnostic tests. Common confirming signs include, but are not limited to: electrocardiogram changes (ST depression, transient ST elevation, or new T-wave inversion) and elevation of cardiac biomarkers from

Stress cardiomyopathy (SCMP), also known as Takotsubo cardiomyopathy or broken heart syndrome, is a clinical condition characterized by acute reversible ventricular dysfunction. It usually affects the left ventricle (LV) and classically involves the mid and apical segments sparing the basal segments. Hence it also has been termed as apical ballooning syndrome. It accounts for approximately 1 to 2% of all troponin proven acute coronary syndrome events. It is typically associated with emotional or physical stressors or seen in the setting of acute medical condition (like surgery, cerebrovascular accident or an asthmatic episode), and is thought to be a catecholamine-mediated injury. These patients regain their ventricular function

Data was collected including Patients age, gender, diagnosis, BP, heart rate, CVP measurement (end of expiration), IVC diameter during expiration and inspiration and intra-abdominal pressures.