SlideShare a Scribd company logo
1 of 81
Download to read offline
John Symanski, MD, Laszlo Littmann, MD,
Jenna Pallansch, MD, Claire Lawson, NP, Shelby Hixson, PA,
Emily Lipsitz, PA, Ashley Moore Gibbs, DNP
Departments of Emergency Medicine and Internal Medicine
Sanger Heart & Vascular Institute
Carolinas Medical Center
Stress-Induced Cardiomyopathy
Michael A. Gibbs, MD, Lead Editor
Carolinas Medical Center Imaging Mastery Project
Visit Our Educational Website
www.EMGuidewire.com
Amyloid
Dilated
• Ischemic
• Peripartum
• Hypertensive
• Iron overload
Genetic
• Hypertrophic
• LV Noncompaction
• ARVC1
Inflammatory (Myocarditis)
• Viral
• Giant cell
• Eosinophilic
• Chagas
• COVID-19
Metabolic
• Diabetic
• Hypothyroid
• Acromegalic
• Cardiac Sarcoid
Stress-Induced (Takotsubo)
Tachycardia-Induced
Toxic
• Alcoholic
• Chemotherapy-induced
• Cocaine-induced
• Other drug related
1Arrhythmogenic Right Ventricular Cardiomyopathy
Classification Of Cardiomyopathies
Selected Embedded References:
Wittstein IS. Neurohormonal Features of Myocardial Stunning Due To Sudden Emotional Stress. New England
Journal of Medicine. 2006; 352:539-548.
Eitel I. Clinical Characteristics and Cardiac MR Findings In Stress Cardiomyopathy. Journal of the American
Medical Association. 2011; 306:277-286.
Amsterdam EA. 2104 AHA/ACC Guidelines for the Management of Patients With Non-ST Segment Acute
Coronary Syndrome. Circulation. 2014; DOI:10.1161/CIR.0000000000000134.
Templin C. Clinical Features And Outcomes Of Stress (Takotsubo) Cardiomyopathy. New England Journal of
Medicine. 2015; 373:10.
Lyon AR. Current state of knowledge on Takotsubo syndrome: a position statement from the task force on
Takotsubo syndrome of the Heart Failure Association of the European Society of Cardiology. European Journal
of Heart Failure. 2016; 18:8-27.
Pelliccia F. Pathophysiology of Takotsubo Cardiomyopathy. Circulation. 2017; 135:2426-2441.
de Chazal HM. Stress Cardiomyopathy Diagnosis and Treatment. JACC State-of-the-Art Review. Journal of the
American College of Cardiology. 2018; 72:1955-1971.
Stress-Induced (Takotsubo)
Cardiomyopathy
Cases Studies From Carolinas Medical Center
Case #1
44-Year-Old
Female
Develops
Chest Pain
After Getting
Into An
Argument
With Her
Best Friend.
Interpreted As Lateral STEMI An Taken For Emergent Cardiac Catheterization
Left Coronary System Right Coronary Artery
Normal Coronary Arteries
Diastole Systole
Left Ventriculogram
Apical Ballooning (*) With Hyperkinetic Basilar Segment (Arrows) Causing LVOT Obstruction
LVOT = Left Ventricular Outflow Tract
*
Diastole Systole
Normal ECG 6 Months Later (Asymptomatic)
Diastole Systole
Diastole Systole
Akinetic Apex
With
Ballooning
Hyperkinetic Basilar Segment
(Potential For LVOT Obstruction)
Case #2
66-Year-Old
Female With A
History Of
Substance
Abuse
Becomes
Upset After
Experiencing A
Relapse.
Diastole Systole
TTE (Apical 4-Chamber) Images
Diastole Systole
TTE (Apical 4-Chamber) Images
Akinetic Apex
With
Ballooning
Hyperkinetic
Basil Segment
And LVOT
Obstruction
Apex Apex
TTE (Apical 2-Chamber) Images
Diastole Systole
TTE (Apical 2-Chamber) Images
Akinetic Apex
With
Ballooning
Hyperkinetic
Basil Segment
And LVOT
Obstruction
ApexApex
Diastole Systole
TTE (Apical 3-Chamber) Images
Diastole Early Systole Late Systole
Note: Systolic Anterior Motion (SAM)
With Septal Contact
Apex
SAM-Associated Flow Acceleration In LVOT (Color Turbulence) And Mitral Regurgitation (Arrow)
Systolic Anterior Motion (SAM) Of The Posterior Leaflet Of The Mitral Valve
Encroaches The Ventricular Septum Causing LVOT Obstruction & Mitral Regurgitation.
Case #4: 75-Year-Old Female Presenting With Chest Pain And Dyspnea, Troponin 2208.
ECG #1: 15:00
Case #4: 75-Year-Old Female Presenting With Chest Pain And Dyspnea, Troponin 2208.
ECG #2: 17:45
Case #4: 75-Year-Old Female Presenting With Chest Pain And Dyspnea, Troponin 2208.
ECG #2: 17:45
Biphasic Precordial T Waves
Emergency Department Point-Of-Care Echocardiogram Apical 4 View
Emergency Department Point-Of-Care Echocardiogram Apical 4 View
Akinetic Apex
With
Ballooning
Formal Echocardiogram: Ejection Fraction 25%
Apex
Definition
First described in Japan in 1990 as Takotsubo Syndrome, it is also known
as stress-induced cardiomyopathy, broken heart syndrome, apical
ballooning syndrome, and acute reversible LV dysfunction.
The Most Widely Used Diagnostic Criteria Are Those From The
European Society Of Cardiology
Pathophysiology
Pathophysiology
Complications
• Acute heart failure
• Torsade de pointes VT related to QT prolongation
• Left ventricular outflow tract obstruction (LVOTO)
• Mitral regurgitations (MR)
• Both LVOTO and MR may lead to cardiogenic shock
• Apical akinesis increases the risk of thromboembolism
• Myocardial rupture (rare)
Epidemiology
• Stress cardiomyopathy occurs predominantly in postmenopausal women.
• Data from three registry studies:
1Templin C.
2Schneider B.
3Citro R.
New Engl J Med 2015.
Int J Cardiol 2013.
J Am Geriatr Soc 2012.
% Female Mean Age
N=1,7501 90% 67 years
N=3242 91% 68 years
N=1903 92% 66 years
From The Original 2001 Japanese Case Series [n=71]
Tsuchihaski K . Journal of the American College of Cardiology. 2001; 38:11-18.
Female 84%
Median age 67 ± 13 years
Associated acute precipitants:
 Medical event
 Emotional event
43%
27%
In-hospital complications:
 Pulmonary edema
 VT/VF
 Cardiogenic shock
22%
9%
15%
Emotional Triggers1
• Death of a loved one
• Tragic news
• Assault, violence, robbery
• Natural disasters
• Sudden financial loss
• A sense of doom, danger, or
desperation
1Roughly 30% of cases have no identifiable trigger.
• Public speaking
• Court appearance
• Personal conflict
• Panic, fear, anxiety
Physical Triggers1
• Critical illness
• Acute injury
• Surgery
• Several pain
• Acute neurologic event
• Heart failure exacerbation
• Asthma exacerbation
• Pheochromocytoma crisis
• Hypertensive emergency
• Preeclampsia
• Cocaine, methamphetamine use
• Large dose of catecholamines,
e.g.: continuous albuterol
1Roughly 30% of cases have no identifiable trigger.
19 Patients
182 Patients
Clinical Manifestations
• The typical history patient with stress cardiomyopathy is a
postmenopausal women who presents with acute or subacute:
• The physical exam reveals a tachypneic, tachycardic patients with signs of
heart failure. A systolic ejection murmur (due to LVOTO and MR) is often
heard.
Chest Pain 75%
Shortness of Breath 50%
Dizziness 25%
Syncope 5-10%
ECG Hallmarks
On Presentation
• Most commonly (80%) the ECG
mimics acute anterior STEMI, but:
• Less prominent ST elevation
• Less reciprocal ST depression
• No abnormal Q waves
• ST depression in aVR is more
common than in STEMI
• Less commonly: diffuse ST
depression and/or T-wave
inversion
24-48 Hours Later
• Diffuse T-wave inversion in  6
leads; aVR and V1 are usually
spared
• Frequently giant negative T waves
• Markedly prolonged QT
• Occasionally: the spiked helmet
sign
ECG Hallmarks
80-Year-Old Female: Prior ECG
QTc = 484 ms
I
II
III F
1
2
3
4
5
6
II
Requested by:
Comment:
Hospital Day #2 For Chest Pain
QTc = 570 ms
I
II
III F
1
2
3
4
5
6
II
Requested by:
Comment:
25 mm/s 10 mm/mV 0.16-150 HzE-Scribe DICOM Module 1.3.6 Atrium Health Mercy
Hospital Day #3 For Chest Pain
QTc = 586 ms
I
II
III F
1
2
3
4
5
6
II
I have personally reviewed the EKG tracing and my findings are listed above: FEDOR, JOHN M
MD 11/12/2020 11:54:03
Requested by:
Comment:
25 mm/s 10 mm/mV 0.16-150 HzE-Scribe DICOM Module 1.3.6 CMC
One Month Later: Asymptomatic
QTc = 461 ms
65-Year-Old With Status Asthmaticus And Acute Chest Pain
ECG ON PRESENTATION: ST ELEVATION IN V2-V4
ECG 48 HRS LATER: LARGE GLOBAL TWI, LONG QT EMERGENT CATHETERIZATION:
NORMAL CORONARY ARTERIES
APICAL BALLOONING
See Appendix 1 At The End Of This Presentation:
“Stress-Induced Cardiomyopathy ECG Case Studies.”
Created by the master ECG educator, Dr. Laszlo Littmann.
Biomarkers
• Cardiac troponin T or I elevated in >90% of patients, although with
lower levels than a classic acute coronary syndrome (ACS)
• Cardiac natriuretic peptides (BNP and pro-BNP) are always elevated,
with higher levels correlating with the degree of wall motion
abnormality and usually greater than that seen with ACS
• Peak biomarker levels occur at 48 hours
Biomarkers
Diagnostic Imaging
Echocardiography
Classic pattern: circumferential LV akinesis involving the entire cardiac apex along with
adjacent basilar hypercontractility
Coronary Angiography
 The decision to proceed with a coronary angiogram should be made on an individual basis
 Elderly patients may have underlying CAD not causing acute ischemia (bystander disease)
 A ventriculogram is diagnostic of stress cardiomyopathy and particularly helpful for the
midventricular form that may be difficult to visualize with echocardiography
Coronary Computed Tomography Angiography
Used to exclude high-grade coronary culprit lesions in patients with limited acoustic windows
and contraindications to CMR
Cardiac Magnetic Resonance
 CMR allows visualization of myocardial edema, inflammation, and scarring with the use of
delayed gadolinium enhancement
 During the acute phase, T2-weighted CMR shows edema as high signal intensity
Cardiac MRI: Gadolinium Enhancement
• Gadolinium containing contrast is widely used in cardiac MRI to
assess the integrity of the myocardium
• Gadolinium is typically taken up and rapidly washed out from healthy
myocardial cells
• In the presence of disease (e.g.: acute and chronic ischemia, prior
infarct, myocarditis, cardiomyopathies) gadolinium remains in
abnormal cardiomyocytes, thus causing late phase enhancement
gadolinium enhancement (LGE) on T1 images
* = Pericardial Effusion; ➤ = Apical Akinesis
➤ = Mid Left Ventricular Akinesis
➤ = Basilar Akinesis
➤ = Basilar Akinesis
* = Pleural Effusions; ➤ = Apical Akinesis ➤ = RV Apex Akinesis
2014 ACC/AHA Non-STEMI Guidelines
STRESS-INDUCED CARDIOMYOPATHY
ECG CASE STUDIES
Dr. Laszlo Littmann, MD
Department of Internal Medicine
Carolinas Medical Center
November 2020
APPENDIX 1
ECG Hallmarks
On Presentation
• Most commonly (80%) the ECG
mimics acute anterior STEMI, but:
• Less prominent ST elevation
• Less reciprocal ST depression
• No abnormal Q waves
• ST depression in aVR is more
common than in STEMI
• Less commonly: diffuse ST
depression and/or T-wave
inversion
24-48 Hours Later
• Diffuse T-wave inversion in  6
leads; aVR and V1 are usually
spared
• Frequently giant negative T waves
• Markedly prolonged QT
• Occasionally: the spiked helmet
sign
65-Year-Old With Status Asthmaticus And Acute Chest Pain
ECG ON PRESENTATION: ST ELEVATION IN V2-V4
ECG 48 HRS LATER: LARGE GLOBAL TWI, LONG QT EMERGENT CATHETERIZATION:
NORMAL CORONARY ARTERIES
APICAL BALLOONING
• Following an acute CNS event:
• Subarachnoid hemorrhage
• Large ICH
• Status epilepticus
• Emotional stress:
• Takotsubo cardiomyopathy
• Any type of adrenergic stress:
• Hypertensive emergency
• Pheochromocytoma attack
• Pulmonary edema
• Severe asthma attack
• Severe trauma
“CEREBRAL T WAVES”
The ECGs All Look
Alike!
Large Near-Global T-Wave Inversion And Marked QT
Prolongation: A Stereotypical Delayed ECG Response To Stress
Cardiomyopathy
NEAR-GLOBAL T-WAVE INVERSION; GIANT NEGATIVE T WAVES; aVR and V1 SPARED
DRAMATICALLY PROLONGED QT
Day 2: Stress-Induced Cardiomyopathy
GLOBAL T WITH PROLONGED QT
NEAR-GLOBAL T-WAVE INVERSION; GIANT NEGATIVE T WAVES; aVR and V1 SPARED
DRAMATICALLY PROLONGED QT
Day 2: Subarachnoid Hemorrhage
GLOBAL T WITH PROLONGED QT
NEAR-GLOBAL T-WAVE INVERSION; GIANT NEGATIVE T WAVES; aVR and V1 SPARED
DRAMATICALLY PROLONGED QT
Day 2: Subarachnoid Hemorrhage
NEAR-GLOBAL T-WAVE INVERSION; GIANT NEGATIVE T WAVES; aVR and V1 SPARED
PROLONGED QT
Day 2: Massive ICH
NEAR-GLOBAL T-WAVE INVERSION; GIANT NEGATIVE T WAVES; aVR and V1 SPARED
DRAMATICALLY PROLONGED QT
After An Episode Of Status Epilepticus
NEAR-GLOBAL T-WAVE INVERSION; GIANT NEGATIVE T WAVES;
aVR and V1 SPARED; PROLONGED QT
Day 2: Acute Pulmonary Edema
NEAR-GLOBAL T-WAVE INVERSION; GIANT NEGATIVE T WAVES; aVR SPARED
DRAMATICALLY PROLONGED QT
Following An Acute COPD Exacerbation
NEAR-GLOBAL T-WAVE INVERSION; GIANT NEGATIVE T WAVES; aVR SPARED
DRAMATICALLY PROLONGED QT
Following An Episode Of Hypertensive Crisis
NEAR-GLOBAL T-WAVE INVERSION; GIANT NEGATIVE T WAVES; aVR and V1 SPARED
DRAMATICALLY PROLONGED QT
ICU Patient With Respiratory Failure & Shock
NEAR-GLOBAL T-WAVE INVERSION; GIANT NEGATIVE T WAVES; aVR and V1 SPARED
PROLONGED QT
Following An Acute Episode Of Cocaine Toxicity
What Is The Significance Of Recognizing
The “T-QT Pattern”?
• If the clinical history and the ECG are typical for stress response, the large
negative T waves do not necessarily indicate ischemia
• Unnecessary cardiac catheterization can be avoided
• Antithrombotic and anti-ischemic treatment may be avoided
• In acute heart failure if stress cardiomyopathy is a reasonable
consideration, the typical “T-QT pattern” can further support this
possibility
If You Have Interesting Cases Of Stress-Induced Cardiomyopathy We Invite You
To Send A Set Of Digital PDF Images And A Brief Descriptive Clinical History To:
michael.gibbs@atriumhealth.org
Your De-Identified Case(s) Will Be Posted On Our Education Website And You
And Your Institution Will Be Recognized!

More Related Content

What's hot

EMGuideWire's Radiology Reading Room: Peripartum Cardiomyopathy
EMGuideWire's Radiology Reading Room: Peripartum CardiomyopathyEMGuideWire's Radiology Reading Room: Peripartum Cardiomyopathy
EMGuideWire's Radiology Reading Room: Peripartum CardiomyopathySean M. Fox
 
Drs. Lorenzen and Barlock’s CMC X-Ray Mastery Project: September Cases
Drs. Lorenzen and Barlock’s CMC X-Ray Mastery Project: September CasesDrs. Lorenzen and Barlock’s CMC X-Ray Mastery Project: September Cases
Drs. Lorenzen and Barlock’s CMC X-Ray Mastery Project: September CasesSean M. Fox
 
EMGuideWire's Radiology Reading Room: Pericardial Effusion
EMGuideWire's Radiology Reading Room: Pericardial EffusionEMGuideWire's Radiology Reading Room: Pericardial Effusion
EMGuideWire's Radiology Reading Room: Pericardial EffusionSean M. Fox
 
EMGuideWire's Radiology Reading Room: Blunt Aortic Injury
EMGuideWire's Radiology Reading Room: Blunt Aortic InjuryEMGuideWire's Radiology Reading Room: Blunt Aortic Injury
EMGuideWire's Radiology Reading Room: Blunt Aortic InjurySean M. Fox
 
EMGuideWire's Radiology Reading Room: Situs Anomalies
EMGuideWire's Radiology Reading Room: Situs AnomaliesEMGuideWire's Radiology Reading Room: Situs Anomalies
EMGuideWire's Radiology Reading Room: Situs AnomaliesSean M. Fox
 
Drs. Lorenzen and Escobar’s CMC X-Ray Mastery Project: August Cases
Drs. Lorenzen and Escobar’s CMC X-Ray Mastery Project: August CasesDrs. Lorenzen and Escobar’s CMC X-Ray Mastery Project: August Cases
Drs. Lorenzen and Escobar’s CMC X-Ray Mastery Project: August CasesSean M. Fox
 
Drs. Lena, Avery, and Davis’s CMC Abdominal Imaging Mastery Project: August C...
Drs. Lena, Avery, and Davis’s CMC Abdominal Imaging Mastery Project: August C...Drs. Lena, Avery, and Davis’s CMC Abdominal Imaging Mastery Project: August C...
Drs. Lena, Avery, and Davis’s CMC Abdominal Imaging Mastery Project: August C...Sean M. Fox
 
Drs. Lorenzen and Escobar’s CMC X-Ray Mastery Project: October Cases
Drs. Lorenzen and Escobar’s CMC X-Ray Mastery Project: October CasesDrs. Lorenzen and Escobar’s CMC X-Ray Mastery Project: October Cases
Drs. Lorenzen and Escobar’s CMC X-Ray Mastery Project: October CasesSean M. Fox
 
Drs. Milam and Thomas's CMC X-Ray Mastery Project: April Cases
Drs. Milam and Thomas's CMC X-Ray Mastery Project: April CasesDrs. Milam and Thomas's CMC X-Ray Mastery Project: April Cases
Drs. Milam and Thomas's CMC X-Ray Mastery Project: April CasesSean M. Fox
 
Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery: April Cases
Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery: April CasesDrs. Potter and Richardson's CMC Pediatric X-Ray Mastery: April Cases
Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery: April CasesSean M. Fox
 
Dr. Michael Gibbs's CMC X-Ray Mastery Project: June cases
Dr. Michael Gibbs's CMC X-Ray Mastery Project: June casesDr. Michael Gibbs's CMC X-Ray Mastery Project: June cases
Dr. Michael Gibbs's CMC X-Ray Mastery Project: June casesSean M. Fox
 
EMGuideWire's Radiology Reading Room: Spontaneous Pneumothorax
EMGuideWire's Radiology Reading Room: Spontaneous PneumothoraxEMGuideWire's Radiology Reading Room: Spontaneous Pneumothorax
EMGuideWire's Radiology Reading Room: Spontaneous PneumothoraxSean M. Fox
 
Drs. Lena, Avery, and Davis’s CMC Abdominal Imaging Mastery Project: March Cases
Drs. Lena, Avery, and Davis’s CMC Abdominal Imaging Mastery Project: March CasesDrs. Lena, Avery, and Davis’s CMC Abdominal Imaging Mastery Project: March Cases
Drs. Lena, Avery, and Davis’s CMC Abdominal Imaging Mastery Project: March CasesSean M. Fox
 
EMGuideWire's Radiology Reading Room: Aortic Dissection
EMGuideWire's Radiology Reading Room: Aortic DissectionEMGuideWire's Radiology Reading Room: Aortic Dissection
EMGuideWire's Radiology Reading Room: Aortic DissectionSean M. Fox
 
EMGuideWire's Radiology Reading Room: Diaphragm Injury Cases
EMGuideWire's Radiology Reading Room: Diaphragm Injury CasesEMGuideWire's Radiology Reading Room: Diaphragm Injury Cases
EMGuideWire's Radiology Reading Room: Diaphragm Injury CasesSean M. Fox
 
ECG changes in anorexia nervosa
ECG changes in anorexia nervosaECG changes in anorexia nervosa
ECG changes in anorexia nervosaSimon Daley
 
Drs. Milam and Thomas's CMC X-Ray Mastery Project: November Cases
Drs. Milam and Thomas's CMC X-Ray Mastery Project: November CasesDrs. Milam and Thomas's CMC X-Ray Mastery Project: November Cases
Drs. Milam and Thomas's CMC X-Ray Mastery Project: November CasesSean M. Fox
 
Drs. Milam and Thomas's CMC X-Ray Mastery Project: July cases
Drs. Milam and Thomas's CMC X-Ray Mastery Project: July casesDrs. Milam and Thomas's CMC X-Ray Mastery Project: July cases
Drs. Milam and Thomas's CMC X-Ray Mastery Project: July casesSean M. Fox
 
Dr. Michael Gibbs's CMC X-Ray Mastery Project - Week #6 Cases
Dr. Michael Gibbs's CMC X-Ray Mastery Project - Week #6 CasesDr. Michael Gibbs's CMC X-Ray Mastery Project - Week #6 Cases
Dr. Michael Gibbs's CMC X-Ray Mastery Project - Week #6 CasesSean M. Fox
 
Drs. Lorenzen and Barlock’s CMC X-Ray Mastery Project: January Cases
Drs. Lorenzen and Barlock’s CMC X-Ray Mastery Project: January CasesDrs. Lorenzen and Barlock’s CMC X-Ray Mastery Project: January Cases
Drs. Lorenzen and Barlock’s CMC X-Ray Mastery Project: January CasesSean M. Fox
 

What's hot (20)

EMGuideWire's Radiology Reading Room: Peripartum Cardiomyopathy
EMGuideWire's Radiology Reading Room: Peripartum CardiomyopathyEMGuideWire's Radiology Reading Room: Peripartum Cardiomyopathy
EMGuideWire's Radiology Reading Room: Peripartum Cardiomyopathy
 
Drs. Lorenzen and Barlock’s CMC X-Ray Mastery Project: September Cases
Drs. Lorenzen and Barlock’s CMC X-Ray Mastery Project: September CasesDrs. Lorenzen and Barlock’s CMC X-Ray Mastery Project: September Cases
Drs. Lorenzen and Barlock’s CMC X-Ray Mastery Project: September Cases
 
EMGuideWire's Radiology Reading Room: Pericardial Effusion
EMGuideWire's Radiology Reading Room: Pericardial EffusionEMGuideWire's Radiology Reading Room: Pericardial Effusion
EMGuideWire's Radiology Reading Room: Pericardial Effusion
 
EMGuideWire's Radiology Reading Room: Blunt Aortic Injury
EMGuideWire's Radiology Reading Room: Blunt Aortic InjuryEMGuideWire's Radiology Reading Room: Blunt Aortic Injury
EMGuideWire's Radiology Reading Room: Blunt Aortic Injury
 
EMGuideWire's Radiology Reading Room: Situs Anomalies
EMGuideWire's Radiology Reading Room: Situs AnomaliesEMGuideWire's Radiology Reading Room: Situs Anomalies
EMGuideWire's Radiology Reading Room: Situs Anomalies
 
Drs. Lorenzen and Escobar’s CMC X-Ray Mastery Project: August Cases
Drs. Lorenzen and Escobar’s CMC X-Ray Mastery Project: August CasesDrs. Lorenzen and Escobar’s CMC X-Ray Mastery Project: August Cases
Drs. Lorenzen and Escobar’s CMC X-Ray Mastery Project: August Cases
 
Drs. Lena, Avery, and Davis’s CMC Abdominal Imaging Mastery Project: August C...
Drs. Lena, Avery, and Davis’s CMC Abdominal Imaging Mastery Project: August C...Drs. Lena, Avery, and Davis’s CMC Abdominal Imaging Mastery Project: August C...
Drs. Lena, Avery, and Davis’s CMC Abdominal Imaging Mastery Project: August C...
 
Drs. Lorenzen and Escobar’s CMC X-Ray Mastery Project: October Cases
Drs. Lorenzen and Escobar’s CMC X-Ray Mastery Project: October CasesDrs. Lorenzen and Escobar’s CMC X-Ray Mastery Project: October Cases
Drs. Lorenzen and Escobar’s CMC X-Ray Mastery Project: October Cases
 
Drs. Milam and Thomas's CMC X-Ray Mastery Project: April Cases
Drs. Milam and Thomas's CMC X-Ray Mastery Project: April CasesDrs. Milam and Thomas's CMC X-Ray Mastery Project: April Cases
Drs. Milam and Thomas's CMC X-Ray Mastery Project: April Cases
 
Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery: April Cases
Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery: April CasesDrs. Potter and Richardson's CMC Pediatric X-Ray Mastery: April Cases
Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery: April Cases
 
Dr. Michael Gibbs's CMC X-Ray Mastery Project: June cases
Dr. Michael Gibbs's CMC X-Ray Mastery Project: June casesDr. Michael Gibbs's CMC X-Ray Mastery Project: June cases
Dr. Michael Gibbs's CMC X-Ray Mastery Project: June cases
 
EMGuideWire's Radiology Reading Room: Spontaneous Pneumothorax
EMGuideWire's Radiology Reading Room: Spontaneous PneumothoraxEMGuideWire's Radiology Reading Room: Spontaneous Pneumothorax
EMGuideWire's Radiology Reading Room: Spontaneous Pneumothorax
 
Drs. Lena, Avery, and Davis’s CMC Abdominal Imaging Mastery Project: March Cases
Drs. Lena, Avery, and Davis’s CMC Abdominal Imaging Mastery Project: March CasesDrs. Lena, Avery, and Davis’s CMC Abdominal Imaging Mastery Project: March Cases
Drs. Lena, Avery, and Davis’s CMC Abdominal Imaging Mastery Project: March Cases
 
EMGuideWire's Radiology Reading Room: Aortic Dissection
EMGuideWire's Radiology Reading Room: Aortic DissectionEMGuideWire's Radiology Reading Room: Aortic Dissection
EMGuideWire's Radiology Reading Room: Aortic Dissection
 
EMGuideWire's Radiology Reading Room: Diaphragm Injury Cases
EMGuideWire's Radiology Reading Room: Diaphragm Injury CasesEMGuideWire's Radiology Reading Room: Diaphragm Injury Cases
EMGuideWire's Radiology Reading Room: Diaphragm Injury Cases
 
ECG changes in anorexia nervosa
ECG changes in anorexia nervosaECG changes in anorexia nervosa
ECG changes in anorexia nervosa
 
Drs. Milam and Thomas's CMC X-Ray Mastery Project: November Cases
Drs. Milam and Thomas's CMC X-Ray Mastery Project: November CasesDrs. Milam and Thomas's CMC X-Ray Mastery Project: November Cases
Drs. Milam and Thomas's CMC X-Ray Mastery Project: November Cases
 
Drs. Milam and Thomas's CMC X-Ray Mastery Project: July cases
Drs. Milam and Thomas's CMC X-Ray Mastery Project: July casesDrs. Milam and Thomas's CMC X-Ray Mastery Project: July cases
Drs. Milam and Thomas's CMC X-Ray Mastery Project: July cases
 
Dr. Michael Gibbs's CMC X-Ray Mastery Project - Week #6 Cases
Dr. Michael Gibbs's CMC X-Ray Mastery Project - Week #6 CasesDr. Michael Gibbs's CMC X-Ray Mastery Project - Week #6 Cases
Dr. Michael Gibbs's CMC X-Ray Mastery Project - Week #6 Cases
 
Drs. Lorenzen and Barlock’s CMC X-Ray Mastery Project: January Cases
Drs. Lorenzen and Barlock’s CMC X-Ray Mastery Project: January CasesDrs. Lorenzen and Barlock’s CMC X-Ray Mastery Project: January Cases
Drs. Lorenzen and Barlock’s CMC X-Ray Mastery Project: January Cases
 

Similar to EMGuideWire's Radiology Reading Room: Stress-Induced Cardiomyopathy

Anaesthetic Management of a Patient with Ischaemic Heart Disease
Anaesthetic Management of a Patient with Ischaemic Heart DiseaseAnaesthetic Management of a Patient with Ischaemic Heart Disease
Anaesthetic Management of a Patient with Ischaemic Heart DiseaseZareer Tafadar
 
Coronary heart disease
Coronary heart diseaseCoronary heart disease
Coronary heart diseaseIvan Luyimbazi
 
03 Samir Rafla-Sudden Cardiac Death and Resuscitation.ppt
03 Samir Rafla-Sudden Cardiac Death and Resuscitation.ppt03 Samir Rafla-Sudden Cardiac Death and Resuscitation.ppt
03 Samir Rafla-Sudden Cardiac Death and Resuscitation.pptAlexandria University, Egypt
 
cardiogenic shock
cardiogenic shock cardiogenic shock
cardiogenic shock Abdul Waris
 
Afshan ali myocardial infarction
Afshan ali myocardial infarctionAfshan ali myocardial infarction
Afshan ali myocardial infarctionAamir Sharif
 
Afshan ali myocardial infarction
Afshan ali myocardial infarctionAfshan ali myocardial infarction
Afshan ali myocardial infarctionAamir Sharif
 
KUHS ESSAYS for final year students including answers
KUHS ESSAYS for final year students including answersKUHS ESSAYS for final year students including answers
KUHS ESSAYS for final year students including answersxjdy4djjzv
 
Afshan ali myocardial infarction
Afshan ali myocardial infarctionAfshan ali myocardial infarction
Afshan ali myocardial infarctionAamir Sharif
 
Acute Coronary Syndrome: MI
Acute Coronary Syndrome: MIAcute Coronary Syndrome: MI
Acute Coronary Syndrome: MIshristi shrestha
 
Acute coronary syndrome presentation with bivalirudin
Acute coronary syndrome presentation with bivalirudinAcute coronary syndrome presentation with bivalirudin
Acute coronary syndrome presentation with bivalirudinRaleifoot Chisolm
 
Cardiogenic shock and IABP.pptx
Cardiogenic shock and IABP.pptxCardiogenic shock and IABP.pptx
Cardiogenic shock and IABP.pptxPRIYANKA BHATI
 

Similar to EMGuideWire's Radiology Reading Room: Stress-Induced Cardiomyopathy (20)

Acute Myocardial infarction
Acute Myocardial infarctionAcute Myocardial infarction
Acute Myocardial infarction
 
How to evaluate shock by echo
How to evaluate shock by echo How to evaluate shock by echo
How to evaluate shock by echo
 
Anaesthetic Management of a Patient with Ischaemic Heart Disease
Anaesthetic Management of a Patient with Ischaemic Heart DiseaseAnaesthetic Management of a Patient with Ischaemic Heart Disease
Anaesthetic Management of a Patient with Ischaemic Heart Disease
 
ECG in young
ECG in youngECG in young
ECG in young
 
Coronary heart disease
Coronary heart diseaseCoronary heart disease
Coronary heart disease
 
ACS.ppt
ACS.pptACS.ppt
ACS.ppt
 
03 Samir Rafla-Sudden Cardiac Death and Resuscitation.ppt
03 Samir Rafla-Sudden Cardiac Death and Resuscitation.ppt03 Samir Rafla-Sudden Cardiac Death and Resuscitation.ppt
03 Samir Rafla-Sudden Cardiac Death and Resuscitation.ppt
 
Acute MI - NSTEMI
Acute MI - NSTEMIAcute MI - NSTEMI
Acute MI - NSTEMI
 
cardiogenic shock
cardiogenic shock cardiogenic shock
cardiogenic shock
 
Afshan ali myocardial infarction
Afshan ali myocardial infarctionAfshan ali myocardial infarction
Afshan ali myocardial infarction
 
Afshan ali myocardial infarction
Afshan ali myocardial infarctionAfshan ali myocardial infarction
Afshan ali myocardial infarction
 
KUHS ESSAYS for final year students including answers
KUHS ESSAYS for final year students including answersKUHS ESSAYS for final year students including answers
KUHS ESSAYS for final year students including answers
 
Afshan ali myocardial infarction
Afshan ali myocardial infarctionAfshan ali myocardial infarction
Afshan ali myocardial infarction
 
Acute Coronary Syndrome: MI
Acute Coronary Syndrome: MIAcute Coronary Syndrome: MI
Acute Coronary Syndrome: MI
 
IHD.pptx
IHD.pptxIHD.pptx
IHD.pptx
 
Myocardialinfarction
Myocardialinfarction Myocardialinfarction
Myocardialinfarction
 
50+ Heart Valve Presentation
50+ Heart Valve Presentation50+ Heart Valve Presentation
50+ Heart Valve Presentation
 
Acute coronary syndrome presentation with bivalirudin
Acute coronary syndrome presentation with bivalirudinAcute coronary syndrome presentation with bivalirudin
Acute coronary syndrome presentation with bivalirudin
 
Cardiogenic shock and IABP.pptx
Cardiogenic shock and IABP.pptxCardiogenic shock and IABP.pptx
Cardiogenic shock and IABP.pptx
 
MI tutorial.pdf
MI tutorial.pdfMI tutorial.pdf
MI tutorial.pdf
 

More from Sean M. Fox

Adult Orthopedic Imaging Series: Presentation #2 Native Hip Dislocations
Adult Orthopedic Imaging Series: Presentation #2 Native Hip DislocationsAdult Orthopedic Imaging Series: Presentation #2 Native Hip Dislocations
Adult Orthopedic Imaging Series: Presentation #2 Native Hip DislocationsSean M. Fox
 
Neuroimaging Mastery Project: Presentation #5 Subdural Hematomas
Neuroimaging Mastery Project: Presentation #5 Subdural HematomasNeuroimaging Mastery Project: Presentation #5 Subdural Hematomas
Neuroimaging Mastery Project: Presentation #5 Subdural HematomasSean M. Fox
 
Neuroimaging Mastery Project Presentation #4: Acute Epidural Hematomas
Neuroimaging Mastery Project Presentation #4: Acute Epidural HematomasNeuroimaging Mastery Project Presentation #4: Acute Epidural Hematomas
Neuroimaging Mastery Project Presentation #4: Acute Epidural HematomasSean M. Fox
 
Pediatric Orthopedic Imaging Case Studies #7 Pediatric Elbow Fractures
Pediatric Orthopedic Imaging Case Studies #7 Pediatric Elbow FracturesPediatric Orthopedic Imaging Case Studies #7 Pediatric Elbow Fractures
Pediatric Orthopedic Imaging Case Studies #7 Pediatric Elbow FracturesSean M. Fox
 
Adult Orthopedic Imaging Mastery Project - Pelvic Ring Fractures
Adult Orthopedic Imaging Mastery Project - Pelvic Ring FracturesAdult Orthopedic Imaging Mastery Project - Pelvic Ring Fractures
Adult Orthopedic Imaging Mastery Project - Pelvic Ring FracturesSean M. Fox
 
Neurosurgical Intracranial Infections - FINAL 10-17-23.pptx
Neurosurgical Intracranial Infections - FINAL 10-17-23.pptxNeurosurgical Intracranial Infections - FINAL 10-17-23.pptx
Neurosurgical Intracranial Infections - FINAL 10-17-23.pptxSean M. Fox
 
CMC Neuroimaging Case Studies - Cerebral Venous Sinus Thrombosis
CMC Neuroimaging Case Studies - Cerebral Venous Sinus ThrombosisCMC Neuroimaging Case Studies - Cerebral Venous Sinus Thrombosis
CMC Neuroimaging Case Studies - Cerebral Venous Sinus ThrombosisSean M. Fox
 
Abdominal Imaging Case Studies #27.pptx
Abdominal Imaging Case Studies #27.pptxAbdominal Imaging Case Studies #27.pptx
Abdominal Imaging Case Studies #27.pptxSean M. Fox
 
Blood Can Be Very Very Bad - CMC Neuroimaging Case Studies
Blood Can Be Very Very Bad - CMC Neuroimaging Case StudiesBlood Can Be Very Very Bad - CMC Neuroimaging Case Studies
Blood Can Be Very Very Bad - CMC Neuroimaging Case StudiesSean M. Fox
 
Adult Chest X-Rays Of The Month - #46
Adult Chest X-Rays Of The Month - #46Adult Chest X-Rays Of The Month - #46
Adult Chest X-Rays Of The Month - #46Sean M. Fox
 
Medical Device Imaging Mastery Project #4: Extracorporeal Membrane Oxygenation
Medical Device Imaging Mastery Project #4: Extracorporeal Membrane OxygenationMedical Device Imaging Mastery Project #4: Extracorporeal Membrane Oxygenation
Medical Device Imaging Mastery Project #4: Extracorporeal Membrane OxygenationSean M. Fox
 
Drs. Pikus, Blackwell, Baumgarten, and Malloy-Posts’s CMC X-Ray Mastery Proje...
Drs. Pikus, Blackwell, Baumgarten, and Malloy-Posts’s CMC X-Ray Mastery Proje...Drs. Pikus, Blackwell, Baumgarten, and Malloy-Posts’s CMC X-Ray Mastery Proje...
Drs. Pikus, Blackwell, Baumgarten, and Malloy-Posts’s CMC X-Ray Mastery Proje...Sean M. Fox
 
Drs. Brooks, Hambright, Holland, and Lorenz’s CMC Abdominal Imaging Mastery P...
Drs. Brooks, Hambright, Holland, and Lorenz’s CMC Abdominal Imaging Mastery P...Drs. Brooks, Hambright, Holland, and Lorenz’s CMC Abdominal Imaging Mastery P...
Drs. Brooks, Hambright, Holland, and Lorenz’s CMC Abdominal Imaging Mastery P...Sean M. Fox
 
CMC Pediatric X-Ray Mastery: 27th Case Series
CMC Pediatric X-Ray Mastery: 27th Case SeriesCMC Pediatric X-Ray Mastery: 27th Case Series
CMC Pediatric X-Ray Mastery: 27th Case SeriesSean M. Fox
 
Dr. Haley Dusek’s CMC Pediatric Orthopedic X-Ray Mastery Project: #6 Presenta...
Dr. Haley Dusek’s CMC Pediatric Orthopedic X-Ray Mastery Project: #6 Presenta...Dr. Haley Dusek’s CMC Pediatric Orthopedic X-Ray Mastery Project: #6 Presenta...
Dr. Haley Dusek’s CMC Pediatric Orthopedic X-Ray Mastery Project: #6 Presenta...Sean M. Fox
 
Drs. Pikus, Blackwell, Baumgarten, and Malloy-Posts’s CMC X-Ray Mastery Proje...
Drs. Pikus, Blackwell, Baumgarten, and Malloy-Posts’s CMC X-Ray Mastery Proje...Drs. Pikus, Blackwell, Baumgarten, and Malloy-Posts’s CMC X-Ray Mastery Proje...
Drs. Pikus, Blackwell, Baumgarten, and Malloy-Posts’s CMC X-Ray Mastery Proje...Sean M. Fox
 
Drs. Escobar, Pikus, and Blackwell’s CMC X-Ray Mastery Project: 43rd Case Series
Drs. Escobar, Pikus, and Blackwell’s CMC X-Ray Mastery Project: 43rd Case SeriesDrs. Escobar, Pikus, and Blackwell’s CMC X-Ray Mastery Project: 43rd Case Series
Drs. Escobar, Pikus, and Blackwell’s CMC X-Ray Mastery Project: 43rd Case SeriesSean M. Fox
 
CMC Pediatric X-Ray Mastery: 26th Case Series
CMC Pediatric X-Ray Mastery: 26th Case SeriesCMC Pediatric X-Ray Mastery: 26th Case Series
CMC Pediatric X-Ray Mastery: 26th Case SeriesSean M. Fox
 
Drs. Penzler, Ricker, and Ahmad’s CMC Abdominal Imaging Mastery Project: June...
Drs. Penzler, Ricker, and Ahmad’s CMC Abdominal Imaging Mastery Project: June...Drs. Penzler, Ricker, and Ahmad’s CMC Abdominal Imaging Mastery Project: June...
Drs. Penzler, Ricker, and Ahmad’s CMC Abdominal Imaging Mastery Project: June...Sean M. Fox
 
Drs. Escobar, Pikus, and Blackwell’s CMC X-Ray Mastery Project: April Cases
Drs. Escobar, Pikus, and Blackwell’s CMC X-Ray Mastery Project: April CasesDrs. Escobar, Pikus, and Blackwell’s CMC X-Ray Mastery Project: April Cases
Drs. Escobar, Pikus, and Blackwell’s CMC X-Ray Mastery Project: April CasesSean M. Fox
 

More from Sean M. Fox (20)

Adult Orthopedic Imaging Series: Presentation #2 Native Hip Dislocations
Adult Orthopedic Imaging Series: Presentation #2 Native Hip DislocationsAdult Orthopedic Imaging Series: Presentation #2 Native Hip Dislocations
Adult Orthopedic Imaging Series: Presentation #2 Native Hip Dislocations
 
Neuroimaging Mastery Project: Presentation #5 Subdural Hematomas
Neuroimaging Mastery Project: Presentation #5 Subdural HematomasNeuroimaging Mastery Project: Presentation #5 Subdural Hematomas
Neuroimaging Mastery Project: Presentation #5 Subdural Hematomas
 
Neuroimaging Mastery Project Presentation #4: Acute Epidural Hematomas
Neuroimaging Mastery Project Presentation #4: Acute Epidural HematomasNeuroimaging Mastery Project Presentation #4: Acute Epidural Hematomas
Neuroimaging Mastery Project Presentation #4: Acute Epidural Hematomas
 
Pediatric Orthopedic Imaging Case Studies #7 Pediatric Elbow Fractures
Pediatric Orthopedic Imaging Case Studies #7 Pediatric Elbow FracturesPediatric Orthopedic Imaging Case Studies #7 Pediatric Elbow Fractures
Pediatric Orthopedic Imaging Case Studies #7 Pediatric Elbow Fractures
 
Adult Orthopedic Imaging Mastery Project - Pelvic Ring Fractures
Adult Orthopedic Imaging Mastery Project - Pelvic Ring FracturesAdult Orthopedic Imaging Mastery Project - Pelvic Ring Fractures
Adult Orthopedic Imaging Mastery Project - Pelvic Ring Fractures
 
Neurosurgical Intracranial Infections - FINAL 10-17-23.pptx
Neurosurgical Intracranial Infections - FINAL 10-17-23.pptxNeurosurgical Intracranial Infections - FINAL 10-17-23.pptx
Neurosurgical Intracranial Infections - FINAL 10-17-23.pptx
 
CMC Neuroimaging Case Studies - Cerebral Venous Sinus Thrombosis
CMC Neuroimaging Case Studies - Cerebral Venous Sinus ThrombosisCMC Neuroimaging Case Studies - Cerebral Venous Sinus Thrombosis
CMC Neuroimaging Case Studies - Cerebral Venous Sinus Thrombosis
 
Abdominal Imaging Case Studies #27.pptx
Abdominal Imaging Case Studies #27.pptxAbdominal Imaging Case Studies #27.pptx
Abdominal Imaging Case Studies #27.pptx
 
Blood Can Be Very Very Bad - CMC Neuroimaging Case Studies
Blood Can Be Very Very Bad - CMC Neuroimaging Case StudiesBlood Can Be Very Very Bad - CMC Neuroimaging Case Studies
Blood Can Be Very Very Bad - CMC Neuroimaging Case Studies
 
Adult Chest X-Rays Of The Month - #46
Adult Chest X-Rays Of The Month - #46Adult Chest X-Rays Of The Month - #46
Adult Chest X-Rays Of The Month - #46
 
Medical Device Imaging Mastery Project #4: Extracorporeal Membrane Oxygenation
Medical Device Imaging Mastery Project #4: Extracorporeal Membrane OxygenationMedical Device Imaging Mastery Project #4: Extracorporeal Membrane Oxygenation
Medical Device Imaging Mastery Project #4: Extracorporeal Membrane Oxygenation
 
Drs. Pikus, Blackwell, Baumgarten, and Malloy-Posts’s CMC X-Ray Mastery Proje...
Drs. Pikus, Blackwell, Baumgarten, and Malloy-Posts’s CMC X-Ray Mastery Proje...Drs. Pikus, Blackwell, Baumgarten, and Malloy-Posts’s CMC X-Ray Mastery Proje...
Drs. Pikus, Blackwell, Baumgarten, and Malloy-Posts’s CMC X-Ray Mastery Proje...
 
Drs. Brooks, Hambright, Holland, and Lorenz’s CMC Abdominal Imaging Mastery P...
Drs. Brooks, Hambright, Holland, and Lorenz’s CMC Abdominal Imaging Mastery P...Drs. Brooks, Hambright, Holland, and Lorenz’s CMC Abdominal Imaging Mastery P...
Drs. Brooks, Hambright, Holland, and Lorenz’s CMC Abdominal Imaging Mastery P...
 
CMC Pediatric X-Ray Mastery: 27th Case Series
CMC Pediatric X-Ray Mastery: 27th Case SeriesCMC Pediatric X-Ray Mastery: 27th Case Series
CMC Pediatric X-Ray Mastery: 27th Case Series
 
Dr. Haley Dusek’s CMC Pediatric Orthopedic X-Ray Mastery Project: #6 Presenta...
Dr. Haley Dusek’s CMC Pediatric Orthopedic X-Ray Mastery Project: #6 Presenta...Dr. Haley Dusek’s CMC Pediatric Orthopedic X-Ray Mastery Project: #6 Presenta...
Dr. Haley Dusek’s CMC Pediatric Orthopedic X-Ray Mastery Project: #6 Presenta...
 
Drs. Pikus, Blackwell, Baumgarten, and Malloy-Posts’s CMC X-Ray Mastery Proje...
Drs. Pikus, Blackwell, Baumgarten, and Malloy-Posts’s CMC X-Ray Mastery Proje...Drs. Pikus, Blackwell, Baumgarten, and Malloy-Posts’s CMC X-Ray Mastery Proje...
Drs. Pikus, Blackwell, Baumgarten, and Malloy-Posts’s CMC X-Ray Mastery Proje...
 
Drs. Escobar, Pikus, and Blackwell’s CMC X-Ray Mastery Project: 43rd Case Series
Drs. Escobar, Pikus, and Blackwell’s CMC X-Ray Mastery Project: 43rd Case SeriesDrs. Escobar, Pikus, and Blackwell’s CMC X-Ray Mastery Project: 43rd Case Series
Drs. Escobar, Pikus, and Blackwell’s CMC X-Ray Mastery Project: 43rd Case Series
 
CMC Pediatric X-Ray Mastery: 26th Case Series
CMC Pediatric X-Ray Mastery: 26th Case SeriesCMC Pediatric X-Ray Mastery: 26th Case Series
CMC Pediatric X-Ray Mastery: 26th Case Series
 
Drs. Penzler, Ricker, and Ahmad’s CMC Abdominal Imaging Mastery Project: June...
Drs. Penzler, Ricker, and Ahmad’s CMC Abdominal Imaging Mastery Project: June...Drs. Penzler, Ricker, and Ahmad’s CMC Abdominal Imaging Mastery Project: June...
Drs. Penzler, Ricker, and Ahmad’s CMC Abdominal Imaging Mastery Project: June...
 
Drs. Escobar, Pikus, and Blackwell’s CMC X-Ray Mastery Project: April Cases
Drs. Escobar, Pikus, and Blackwell’s CMC X-Ray Mastery Project: April CasesDrs. Escobar, Pikus, and Blackwell’s CMC X-Ray Mastery Project: April Cases
Drs. Escobar, Pikus, and Blackwell’s CMC X-Ray Mastery Project: April Cases
 

Recently uploaded

16. Discovery, function and commercial uses of different PGRS.pptx
16. Discovery, function and commercial uses of different PGRS.pptx16. Discovery, function and commercial uses of different PGRS.pptx
16. Discovery, function and commercial uses of different PGRS.pptxUmeshTimilsina1
 
4.9.24 Social Capital and Social Exclusion.pptx
4.9.24 Social Capital and Social Exclusion.pptx4.9.24 Social Capital and Social Exclusion.pptx
4.9.24 Social Capital and Social Exclusion.pptxmary850239
 
4.4.24 Economic Precarity and Global Economic Forces.pptx
4.4.24 Economic Precarity and Global Economic Forces.pptx4.4.24 Economic Precarity and Global Economic Forces.pptx
4.4.24 Economic Precarity and Global Economic Forces.pptxmary850239
 
Jason Potel In Media Res Media Component
Jason Potel In Media Res Media ComponentJason Potel In Media Res Media Component
Jason Potel In Media Res Media ComponentInMediaRes1
 
Employablity presentation and Future Career Plan.pptx
Employablity presentation and Future Career Plan.pptxEmployablity presentation and Future Career Plan.pptx
Employablity presentation and Future Career Plan.pptxryandux83rd
 
DORA, ISO/IEC 27005, and the Rise of AI: Securing the Future of Cybersecurity
DORA, ISO/IEC 27005, and the Rise of AI: Securing the Future of CybersecurityDORA, ISO/IEC 27005, and the Rise of AI: Securing the Future of Cybersecurity
DORA, ISO/IEC 27005, and the Rise of AI: Securing the Future of CybersecurityPECB
 
BÀI TẬP BỔ TRỢ TIẾNG ANH 11 THEO ĐƠN VỊ BÀI HỌC - CẢ NĂM - CÓ FILE NGHE (GLOB...
BÀI TẬP BỔ TRỢ TIẾNG ANH 11 THEO ĐƠN VỊ BÀI HỌC - CẢ NĂM - CÓ FILE NGHE (GLOB...BÀI TẬP BỔ TRỢ TIẾNG ANH 11 THEO ĐƠN VỊ BÀI HỌC - CẢ NĂM - CÓ FILE NGHE (GLOB...
BÀI TẬP BỔ TRỢ TIẾNG ANH 11 THEO ĐƠN VỊ BÀI HỌC - CẢ NĂM - CÓ FILE NGHE (GLOB...Nguyen Thanh Tu Collection
 
Sarah Lahm In Media Res Media Component
Sarah Lahm  In Media Res Media ComponentSarah Lahm  In Media Res Media Component
Sarah Lahm In Media Res Media ComponentInMediaRes1
 
Jordan Chrietzberg In Media Res Media Component
Jordan Chrietzberg In Media Res Media ComponentJordan Chrietzberg In Media Res Media Component
Jordan Chrietzberg In Media Res Media ComponentInMediaRes1
 
HackerOne X IoT Lab Bug Bounty 101 with Encryptsaan & IoT Lab at KIIT Univers...
HackerOne X IoT Lab Bug Bounty 101 with Encryptsaan & IoT Lab at KIIT Univers...HackerOne X IoT Lab Bug Bounty 101 with Encryptsaan & IoT Lab at KIIT Univers...
HackerOne X IoT Lab Bug Bounty 101 with Encryptsaan & IoT Lab at KIIT Univers...kumarpriyanshu81
 
Healthy Minds, Flourishing Lives: A Philosophical Approach to Mental Health a...
Healthy Minds, Flourishing Lives: A Philosophical Approach to Mental Health a...Healthy Minds, Flourishing Lives: A Philosophical Approach to Mental Health a...
Healthy Minds, Flourishing Lives: A Philosophical Approach to Mental Health a...Osopher
 
The Emergence of Legislative Behavior in the Colombian Congress
The Emergence of Legislative Behavior in the Colombian CongressThe Emergence of Legislative Behavior in the Colombian Congress
The Emergence of Legislative Behavior in the Colombian CongressMaria Paula Aroca
 
Farrington HS Streamlines Guest Entrance
Farrington HS Streamlines Guest EntranceFarrington HS Streamlines Guest Entrance
Farrington HS Streamlines Guest Entrancejulius27264
 
LEVERAGING SYNERGISM INDUSTRY-ACADEMIA PARTNERSHIP FOR IMPLEMENTATION OF NAT...
LEVERAGING SYNERGISM INDUSTRY-ACADEMIA PARTNERSHIP FOR IMPLEMENTATION OF  NAT...LEVERAGING SYNERGISM INDUSTRY-ACADEMIA PARTNERSHIP FOR IMPLEMENTATION OF  NAT...
LEVERAGING SYNERGISM INDUSTRY-ACADEMIA PARTNERSHIP FOR IMPLEMENTATION OF NAT...pragatimahajan3
 
4.9.24 School Desegregation in Boston.pptx
4.9.24 School Desegregation in Boston.pptx4.9.24 School Desegregation in Boston.pptx
4.9.24 School Desegregation in Boston.pptxmary850239
 
The role of Geography in climate education: science and active citizenship
The role of Geography in climate education: science and active citizenshipThe role of Geography in climate education: science and active citizenship
The role of Geography in climate education: science and active citizenshipKarl Donert
 
Supply agency market - aiming high 2.pdf
Supply agency market - aiming high 2.pdfSupply agency market - aiming high 2.pdf
Supply agency market - aiming high 2.pdftomeskell101
 
647291105-Ppt-Arts-10-4th-Quarter-1.pdfi
647291105-Ppt-Arts-10-4th-Quarter-1.pdfi647291105-Ppt-Arts-10-4th-Quarter-1.pdfi
647291105-Ppt-Arts-10-4th-Quarter-1.pdfijoemmbrillantes
 

Recently uploaded (20)

16. Discovery, function and commercial uses of different PGRS.pptx
16. Discovery, function and commercial uses of different PGRS.pptx16. Discovery, function and commercial uses of different PGRS.pptx
16. Discovery, function and commercial uses of different PGRS.pptx
 
4.9.24 Social Capital and Social Exclusion.pptx
4.9.24 Social Capital and Social Exclusion.pptx4.9.24 Social Capital and Social Exclusion.pptx
4.9.24 Social Capital and Social Exclusion.pptx
 
4.4.24 Economic Precarity and Global Economic Forces.pptx
4.4.24 Economic Precarity and Global Economic Forces.pptx4.4.24 Economic Precarity and Global Economic Forces.pptx
4.4.24 Economic Precarity and Global Economic Forces.pptx
 
Jason Potel In Media Res Media Component
Jason Potel In Media Res Media ComponentJason Potel In Media Res Media Component
Jason Potel In Media Res Media Component
 
Employablity presentation and Future Career Plan.pptx
Employablity presentation and Future Career Plan.pptxEmployablity presentation and Future Career Plan.pptx
Employablity presentation and Future Career Plan.pptx
 
Israel Genealogy Research Assoc. April 2024 Database Release
Israel Genealogy Research Assoc. April 2024 Database ReleaseIsrael Genealogy Research Assoc. April 2024 Database Release
Israel Genealogy Research Assoc. April 2024 Database Release
 
DORA, ISO/IEC 27005, and the Rise of AI: Securing the Future of Cybersecurity
DORA, ISO/IEC 27005, and the Rise of AI: Securing the Future of CybersecurityDORA, ISO/IEC 27005, and the Rise of AI: Securing the Future of Cybersecurity
DORA, ISO/IEC 27005, and the Rise of AI: Securing the Future of Cybersecurity
 
BÀI TẬP BỔ TRỢ TIẾNG ANH 11 THEO ĐƠN VỊ BÀI HỌC - CẢ NĂM - CÓ FILE NGHE (GLOB...
BÀI TẬP BỔ TRỢ TIẾNG ANH 11 THEO ĐƠN VỊ BÀI HỌC - CẢ NĂM - CÓ FILE NGHE (GLOB...BÀI TẬP BỔ TRỢ TIẾNG ANH 11 THEO ĐƠN VỊ BÀI HỌC - CẢ NĂM - CÓ FILE NGHE (GLOB...
BÀI TẬP BỔ TRỢ TIẾNG ANH 11 THEO ĐƠN VỊ BÀI HỌC - CẢ NĂM - CÓ FILE NGHE (GLOB...
 
Sarah Lahm In Media Res Media Component
Sarah Lahm  In Media Res Media ComponentSarah Lahm  In Media Res Media Component
Sarah Lahm In Media Res Media Component
 
Jordan Chrietzberg In Media Res Media Component
Jordan Chrietzberg In Media Res Media ComponentJordan Chrietzberg In Media Res Media Component
Jordan Chrietzberg In Media Res Media Component
 
HackerOne X IoT Lab Bug Bounty 101 with Encryptsaan & IoT Lab at KIIT Univers...
HackerOne X IoT Lab Bug Bounty 101 with Encryptsaan & IoT Lab at KIIT Univers...HackerOne X IoT Lab Bug Bounty 101 with Encryptsaan & IoT Lab at KIIT Univers...
HackerOne X IoT Lab Bug Bounty 101 with Encryptsaan & IoT Lab at KIIT Univers...
 
Healthy Minds, Flourishing Lives: A Philosophical Approach to Mental Health a...
Healthy Minds, Flourishing Lives: A Philosophical Approach to Mental Health a...Healthy Minds, Flourishing Lives: A Philosophical Approach to Mental Health a...
Healthy Minds, Flourishing Lives: A Philosophical Approach to Mental Health a...
 
The Emergence of Legislative Behavior in the Colombian Congress
The Emergence of Legislative Behavior in the Colombian CongressThe Emergence of Legislative Behavior in the Colombian Congress
The Emergence of Legislative Behavior in the Colombian Congress
 
Farrington HS Streamlines Guest Entrance
Farrington HS Streamlines Guest EntranceFarrington HS Streamlines Guest Entrance
Farrington HS Streamlines Guest Entrance
 
LEVERAGING SYNERGISM INDUSTRY-ACADEMIA PARTNERSHIP FOR IMPLEMENTATION OF NAT...
LEVERAGING SYNERGISM INDUSTRY-ACADEMIA PARTNERSHIP FOR IMPLEMENTATION OF  NAT...LEVERAGING SYNERGISM INDUSTRY-ACADEMIA PARTNERSHIP FOR IMPLEMENTATION OF  NAT...
LEVERAGING SYNERGISM INDUSTRY-ACADEMIA PARTNERSHIP FOR IMPLEMENTATION OF NAT...
 
4.9.24 School Desegregation in Boston.pptx
4.9.24 School Desegregation in Boston.pptx4.9.24 School Desegregation in Boston.pptx
4.9.24 School Desegregation in Boston.pptx
 
The role of Geography in climate education: science and active citizenship
The role of Geography in climate education: science and active citizenshipThe role of Geography in climate education: science and active citizenship
The role of Geography in climate education: science and active citizenship
 
Supply agency market - aiming high 2.pdf
Supply agency market - aiming high 2.pdfSupply agency market - aiming high 2.pdf
Supply agency market - aiming high 2.pdf
 
647291105-Ppt-Arts-10-4th-Quarter-1.pdfi
647291105-Ppt-Arts-10-4th-Quarter-1.pdfi647291105-Ppt-Arts-10-4th-Quarter-1.pdfi
647291105-Ppt-Arts-10-4th-Quarter-1.pdfi
 
Mattingly "AI & Prompt Design" - Introduction to Machine Learning"
Mattingly "AI & Prompt Design" - Introduction to Machine Learning"Mattingly "AI & Prompt Design" - Introduction to Machine Learning"
Mattingly "AI & Prompt Design" - Introduction to Machine Learning"
 

EMGuideWire's Radiology Reading Room: Stress-Induced Cardiomyopathy

  • 1. John Symanski, MD, Laszlo Littmann, MD, Jenna Pallansch, MD, Claire Lawson, NP, Shelby Hixson, PA, Emily Lipsitz, PA, Ashley Moore Gibbs, DNP Departments of Emergency Medicine and Internal Medicine Sanger Heart & Vascular Institute Carolinas Medical Center Stress-Induced Cardiomyopathy Michael A. Gibbs, MD, Lead Editor Carolinas Medical Center Imaging Mastery Project
  • 2. Visit Our Educational Website www.EMGuidewire.com
  • 3. Amyloid Dilated • Ischemic • Peripartum • Hypertensive • Iron overload Genetic • Hypertrophic • LV Noncompaction • ARVC1 Inflammatory (Myocarditis) • Viral • Giant cell • Eosinophilic • Chagas • COVID-19 Metabolic • Diabetic • Hypothyroid • Acromegalic • Cardiac Sarcoid Stress-Induced (Takotsubo) Tachycardia-Induced Toxic • Alcoholic • Chemotherapy-induced • Cocaine-induced • Other drug related 1Arrhythmogenic Right Ventricular Cardiomyopathy Classification Of Cardiomyopathies
  • 4. Selected Embedded References: Wittstein IS. Neurohormonal Features of Myocardial Stunning Due To Sudden Emotional Stress. New England Journal of Medicine. 2006; 352:539-548. Eitel I. Clinical Characteristics and Cardiac MR Findings In Stress Cardiomyopathy. Journal of the American Medical Association. 2011; 306:277-286. Amsterdam EA. 2104 AHA/ACC Guidelines for the Management of Patients With Non-ST Segment Acute Coronary Syndrome. Circulation. 2014; DOI:10.1161/CIR.0000000000000134. Templin C. Clinical Features And Outcomes Of Stress (Takotsubo) Cardiomyopathy. New England Journal of Medicine. 2015; 373:10. Lyon AR. Current state of knowledge on Takotsubo syndrome: a position statement from the task force on Takotsubo syndrome of the Heart Failure Association of the European Society of Cardiology. European Journal of Heart Failure. 2016; 18:8-27. Pelliccia F. Pathophysiology of Takotsubo Cardiomyopathy. Circulation. 2017; 135:2426-2441. de Chazal HM. Stress Cardiomyopathy Diagnosis and Treatment. JACC State-of-the-Art Review. Journal of the American College of Cardiology. 2018; 72:1955-1971.
  • 6. Case #1 44-Year-Old Female Develops Chest Pain After Getting Into An Argument With Her Best Friend.
  • 7.
  • 8. Interpreted As Lateral STEMI An Taken For Emergent Cardiac Catheterization
  • 9. Left Coronary System Right Coronary Artery Normal Coronary Arteries
  • 11. Apical Ballooning (*) With Hyperkinetic Basilar Segment (Arrows) Causing LVOT Obstruction LVOT = Left Ventricular Outflow Tract * Diastole Systole
  • 12. Normal ECG 6 Months Later (Asymptomatic)
  • 14. Diastole Systole Akinetic Apex With Ballooning Hyperkinetic Basilar Segment (Potential For LVOT Obstruction)
  • 15. Case #2 66-Year-Old Female With A History Of Substance Abuse Becomes Upset After Experiencing A Relapse.
  • 16. Diastole Systole TTE (Apical 4-Chamber) Images
  • 17. Diastole Systole TTE (Apical 4-Chamber) Images Akinetic Apex With Ballooning Hyperkinetic Basil Segment And LVOT Obstruction Apex Apex
  • 18. TTE (Apical 2-Chamber) Images Diastole Systole
  • 19. TTE (Apical 2-Chamber) Images Akinetic Apex With Ballooning Hyperkinetic Basil Segment And LVOT Obstruction ApexApex Diastole Systole
  • 20. TTE (Apical 3-Chamber) Images Diastole Early Systole Late Systole Note: Systolic Anterior Motion (SAM) With Septal Contact Apex
  • 21. SAM-Associated Flow Acceleration In LVOT (Color Turbulence) And Mitral Regurgitation (Arrow)
  • 22. Systolic Anterior Motion (SAM) Of The Posterior Leaflet Of The Mitral Valve Encroaches The Ventricular Septum Causing LVOT Obstruction & Mitral Regurgitation.
  • 23. Case #4: 75-Year-Old Female Presenting With Chest Pain And Dyspnea, Troponin 2208. ECG #1: 15:00
  • 24. Case #4: 75-Year-Old Female Presenting With Chest Pain And Dyspnea, Troponin 2208. ECG #2: 17:45
  • 25. Case #4: 75-Year-Old Female Presenting With Chest Pain And Dyspnea, Troponin 2208. ECG #2: 17:45 Biphasic Precordial T Waves
  • 26. Emergency Department Point-Of-Care Echocardiogram Apical 4 View
  • 27. Emergency Department Point-Of-Care Echocardiogram Apical 4 View Akinetic Apex With Ballooning Formal Echocardiogram: Ejection Fraction 25% Apex
  • 28. Definition First described in Japan in 1990 as Takotsubo Syndrome, it is also known as stress-induced cardiomyopathy, broken heart syndrome, apical ballooning syndrome, and acute reversible LV dysfunction.
  • 29. The Most Widely Used Diagnostic Criteria Are Those From The European Society Of Cardiology
  • 32.
  • 33.
  • 34.
  • 35.
  • 36.
  • 37.
  • 38. Complications • Acute heart failure • Torsade de pointes VT related to QT prolongation • Left ventricular outflow tract obstruction (LVOTO) • Mitral regurgitations (MR) • Both LVOTO and MR may lead to cardiogenic shock • Apical akinesis increases the risk of thromboembolism • Myocardial rupture (rare)
  • 39. Epidemiology • Stress cardiomyopathy occurs predominantly in postmenopausal women. • Data from three registry studies: 1Templin C. 2Schneider B. 3Citro R. New Engl J Med 2015. Int J Cardiol 2013. J Am Geriatr Soc 2012. % Female Mean Age N=1,7501 90% 67 years N=3242 91% 68 years N=1903 92% 66 years
  • 40. From The Original 2001 Japanese Case Series [n=71] Tsuchihaski K . Journal of the American College of Cardiology. 2001; 38:11-18. Female 84% Median age 67 ± 13 years Associated acute precipitants:  Medical event  Emotional event 43% 27% In-hospital complications:  Pulmonary edema  VT/VF  Cardiogenic shock 22% 9% 15%
  • 41. Emotional Triggers1 • Death of a loved one • Tragic news • Assault, violence, robbery • Natural disasters • Sudden financial loss • A sense of doom, danger, or desperation 1Roughly 30% of cases have no identifiable trigger. • Public speaking • Court appearance • Personal conflict • Panic, fear, anxiety
  • 42. Physical Triggers1 • Critical illness • Acute injury • Surgery • Several pain • Acute neurologic event • Heart failure exacerbation • Asthma exacerbation • Pheochromocytoma crisis • Hypertensive emergency • Preeclampsia • Cocaine, methamphetamine use • Large dose of catecholamines, e.g.: continuous albuterol 1Roughly 30% of cases have no identifiable trigger.
  • 45. Clinical Manifestations • The typical history patient with stress cardiomyopathy is a postmenopausal women who presents with acute or subacute: • The physical exam reveals a tachypneic, tachycardic patients with signs of heart failure. A systolic ejection murmur (due to LVOTO and MR) is often heard. Chest Pain 75% Shortness of Breath 50% Dizziness 25% Syncope 5-10%
  • 46. ECG Hallmarks On Presentation • Most commonly (80%) the ECG mimics acute anterior STEMI, but: • Less prominent ST elevation • Less reciprocal ST depression • No abnormal Q waves • ST depression in aVR is more common than in STEMI • Less commonly: diffuse ST depression and/or T-wave inversion 24-48 Hours Later • Diffuse T-wave inversion in  6 leads; aVR and V1 are usually spared • Frequently giant negative T waves • Markedly prolonged QT • Occasionally: the spiked helmet sign
  • 48. 80-Year-Old Female: Prior ECG QTc = 484 ms
  • 49. I II III F 1 2 3 4 5 6 II Requested by: Comment: Hospital Day #2 For Chest Pain QTc = 570 ms
  • 50. I II III F 1 2 3 4 5 6 II Requested by: Comment: 25 mm/s 10 mm/mV 0.16-150 HzE-Scribe DICOM Module 1.3.6 Atrium Health Mercy Hospital Day #3 For Chest Pain QTc = 586 ms
  • 51. I II III F 1 2 3 4 5 6 II I have personally reviewed the EKG tracing and my findings are listed above: FEDOR, JOHN M MD 11/12/2020 11:54:03 Requested by: Comment: 25 mm/s 10 mm/mV 0.16-150 HzE-Scribe DICOM Module 1.3.6 CMC One Month Later: Asymptomatic QTc = 461 ms
  • 52. 65-Year-Old With Status Asthmaticus And Acute Chest Pain ECG ON PRESENTATION: ST ELEVATION IN V2-V4 ECG 48 HRS LATER: LARGE GLOBAL TWI, LONG QT EMERGENT CATHETERIZATION: NORMAL CORONARY ARTERIES APICAL BALLOONING
  • 53. See Appendix 1 At The End Of This Presentation: “Stress-Induced Cardiomyopathy ECG Case Studies.” Created by the master ECG educator, Dr. Laszlo Littmann.
  • 54. Biomarkers • Cardiac troponin T or I elevated in >90% of patients, although with lower levels than a classic acute coronary syndrome (ACS) • Cardiac natriuretic peptides (BNP and pro-BNP) are always elevated, with higher levels correlating with the degree of wall motion abnormality and usually greater than that seen with ACS • Peak biomarker levels occur at 48 hours
  • 56. Diagnostic Imaging Echocardiography Classic pattern: circumferential LV akinesis involving the entire cardiac apex along with adjacent basilar hypercontractility Coronary Angiography  The decision to proceed with a coronary angiogram should be made on an individual basis  Elderly patients may have underlying CAD not causing acute ischemia (bystander disease)  A ventriculogram is diagnostic of stress cardiomyopathy and particularly helpful for the midventricular form that may be difficult to visualize with echocardiography Coronary Computed Tomography Angiography Used to exclude high-grade coronary culprit lesions in patients with limited acoustic windows and contraindications to CMR Cardiac Magnetic Resonance  CMR allows visualization of myocardial edema, inflammation, and scarring with the use of delayed gadolinium enhancement  During the acute phase, T2-weighted CMR shows edema as high signal intensity
  • 57. Cardiac MRI: Gadolinium Enhancement • Gadolinium containing contrast is widely used in cardiac MRI to assess the integrity of the myocardium • Gadolinium is typically taken up and rapidly washed out from healthy myocardial cells • In the presence of disease (e.g.: acute and chronic ischemia, prior infarct, myocarditis, cardiomyopathies) gadolinium remains in abnormal cardiomyocytes, thus causing late phase enhancement gadolinium enhancement (LGE) on T1 images
  • 58.
  • 59. * = Pericardial Effusion; ➤ = Apical Akinesis
  • 60. ➤ = Mid Left Ventricular Akinesis
  • 61. ➤ = Basilar Akinesis
  • 62. ➤ = Basilar Akinesis * = Pleural Effusions; ➤ = Apical Akinesis ➤ = RV Apex Akinesis
  • 63.
  • 65.
  • 66. STRESS-INDUCED CARDIOMYOPATHY ECG CASE STUDIES Dr. Laszlo Littmann, MD Department of Internal Medicine Carolinas Medical Center November 2020 APPENDIX 1
  • 67. ECG Hallmarks On Presentation • Most commonly (80%) the ECG mimics acute anterior STEMI, but: • Less prominent ST elevation • Less reciprocal ST depression • No abnormal Q waves • ST depression in aVR is more common than in STEMI • Less commonly: diffuse ST depression and/or T-wave inversion 24-48 Hours Later • Diffuse T-wave inversion in  6 leads; aVR and V1 are usually spared • Frequently giant negative T waves • Markedly prolonged QT • Occasionally: the spiked helmet sign
  • 68. 65-Year-Old With Status Asthmaticus And Acute Chest Pain ECG ON PRESENTATION: ST ELEVATION IN V2-V4 ECG 48 HRS LATER: LARGE GLOBAL TWI, LONG QT EMERGENT CATHETERIZATION: NORMAL CORONARY ARTERIES APICAL BALLOONING
  • 69. • Following an acute CNS event: • Subarachnoid hemorrhage • Large ICH • Status epilepticus • Emotional stress: • Takotsubo cardiomyopathy • Any type of adrenergic stress: • Hypertensive emergency • Pheochromocytoma attack • Pulmonary edema • Severe asthma attack • Severe trauma “CEREBRAL T WAVES” The ECGs All Look Alike! Large Near-Global T-Wave Inversion And Marked QT Prolongation: A Stereotypical Delayed ECG Response To Stress Cardiomyopathy
  • 70. NEAR-GLOBAL T-WAVE INVERSION; GIANT NEGATIVE T WAVES; aVR and V1 SPARED DRAMATICALLY PROLONGED QT Day 2: Stress-Induced Cardiomyopathy
  • 71. GLOBAL T WITH PROLONGED QT NEAR-GLOBAL T-WAVE INVERSION; GIANT NEGATIVE T WAVES; aVR and V1 SPARED DRAMATICALLY PROLONGED QT Day 2: Subarachnoid Hemorrhage
  • 72. GLOBAL T WITH PROLONGED QT NEAR-GLOBAL T-WAVE INVERSION; GIANT NEGATIVE T WAVES; aVR and V1 SPARED DRAMATICALLY PROLONGED QT Day 2: Subarachnoid Hemorrhage
  • 73. NEAR-GLOBAL T-WAVE INVERSION; GIANT NEGATIVE T WAVES; aVR and V1 SPARED PROLONGED QT Day 2: Massive ICH
  • 74. NEAR-GLOBAL T-WAVE INVERSION; GIANT NEGATIVE T WAVES; aVR and V1 SPARED DRAMATICALLY PROLONGED QT After An Episode Of Status Epilepticus
  • 75. NEAR-GLOBAL T-WAVE INVERSION; GIANT NEGATIVE T WAVES; aVR and V1 SPARED; PROLONGED QT Day 2: Acute Pulmonary Edema
  • 76. NEAR-GLOBAL T-WAVE INVERSION; GIANT NEGATIVE T WAVES; aVR SPARED DRAMATICALLY PROLONGED QT Following An Acute COPD Exacerbation
  • 77. NEAR-GLOBAL T-WAVE INVERSION; GIANT NEGATIVE T WAVES; aVR SPARED DRAMATICALLY PROLONGED QT Following An Episode Of Hypertensive Crisis
  • 78. NEAR-GLOBAL T-WAVE INVERSION; GIANT NEGATIVE T WAVES; aVR and V1 SPARED DRAMATICALLY PROLONGED QT ICU Patient With Respiratory Failure & Shock
  • 79. NEAR-GLOBAL T-WAVE INVERSION; GIANT NEGATIVE T WAVES; aVR and V1 SPARED PROLONGED QT Following An Acute Episode Of Cocaine Toxicity
  • 80. What Is The Significance Of Recognizing The “T-QT Pattern”? • If the clinical history and the ECG are typical for stress response, the large negative T waves do not necessarily indicate ischemia • Unnecessary cardiac catheterization can be avoided • Antithrombotic and anti-ischemic treatment may be avoided • In acute heart failure if stress cardiomyopathy is a reasonable consideration, the typical “T-QT pattern” can further support this possibility
  • 81. If You Have Interesting Cases Of Stress-Induced Cardiomyopathy We Invite You To Send A Set Of Digital PDF Images And A Brief Descriptive Clinical History To: michael.gibbs@atriumhealth.org Your De-Identified Case(s) Will Be Posted On Our Education Website And You And Your Institution Will Be Recognized!