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I didn’t say “Cheese”!! – Conclusion

by on May 23, 2011

Here is the conclusion to I didn’t say “Cheese”!!

This patient presented as an anterior lateral STEMI. She had elevated Troponin Level of 3.580 (H) The normal Troponin level is < 0.4 ng/mL
She also had ST elevation in leads V3-V6. There is no noted Reciprocal changes in the Inferior leads

ECHO – EF = 35%; “mid anterseptal, apical septal, apical anterior, apical lateral and apical inferior wall segments akinetic.”

She was taken to the Cath Lab
The final diagnosis:


Takotsubo is a type of non-ischemic cardiomyopathy in which there is a sudden temporary weakening of the myocardium (the muscle of the heart). Because this weakening can be triggered by emotional stress, such as the death of a loved one, a break-up, or constant rejection, the condition is also known as broken heart syndrome
The typical presentation of someone with takotsubo cardiomyopathy is a sudden onset of congestive heart failure or chest pain associated with ECG changes suggestive of an anterior wall myocardial infarction. During the course of evaluation of the patient, a bulging out of the left ventricular apex with a hypercontractile base of the left ventricle is often noted. It is the hallmark bulging out of the apex of the heart with preserved function of the base that earned the syndrome its name “tako tsubo”, or octopus trap in Japan, where it was first described. The cause appears to involve high circulating levels of catecholamines (mainly adrenaline/epinephrine). Evaluation of individuals with takotsubo cardiomyopathy typically includes a coronary angiogram, which will not reveal any significant blockages that would cause the left ventricular dysfunction. Provided that the individual survives their initial presentation, the left ventricular function improves within 2 months. Takotsubo cardiomyopathy is more commonly seen in post-menopausal women. Often there is a history of a recent severe emotional or physical stress.
Read more about Takotsubo

From → Case File, Education

  1. MediMike permalink

    So in regards to this case, if there was no ischemic/infarcted tissue, what caused the elevated troponin levels? (I could be way off and just unable to read the angiograms haha)

    • The troponin test can be used as a test of several different heart disorders, including myocardial infarction.”

      “Certain subtypes of troponin (cardiac troponin I and T) are very sensitive and specific indicators of damage to the heart muscle (myocardium). They are measured in the blood to differentiate between unstable angina and myocardial infarction (heart attack) in patients with chest pain or acute coronary syndrome. A patient who had suffered from a myocardial infarction would have an area of damaged heart muscle and so would have elevated cardiac troponin levels in the blood. This can also occur in patients with coronary vasospasm.

      It is important to note that cardiac troponins are a marker of all heart muscle damage, not just myocardial infarction. Other conditions that directly or indirectly lead to heart muscle damage can also increase troponin levels. Severe tachycardia (for example due to supraventricular tachycardia) in an individual with normal coronary arteries can also lead to increased troponins for example, presumably due to increased oxygen demand and inadequate supply to the heart muscle.

      Troponins are also increased in patients with heart failure, where they also predict mortality and ventricular rhythm abnormalities. They can rise in inflammatory conditions such as myocarditis and pericarditis with heart muscle involvement (which is then termed myopericarditis). Troponins can also indicate several forms of cardiomyopathy, such as dilated cardiomyopathy, hypertrophic cardiomyopathy or (left) ventricular hypertrophy, peripartum cardiomyopathy, Takotsubo cardiomyopathy or infiltrative disorders such as cardiac amyloidosis.
      Heart injury with increased troponins also occurs in cardiac contusion, defibrillation and internal or external cardioversion. Increased troponins are commonly increased in several procedures such as cardiac surgery and heart transplantation, closure of atrial septal defects, percutaneous coronary intervention or radiofrequency ablation.”
      Source and further information:

      Read more: How is an elevated troponin level indicative of a myocardial infarction? What other labl tests might be done to confirm a myocardial infarction? | Answerbag

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