Guess the EKG.

[VFlutter]

I understand what part of the ECG in particular directed you to immediately know it was such a random condition :sad:

In Inferior/RV MIs the STE in lead III is greater than lead II which indicates RCA occlusion, it is rare to see it the other way around. When II > III it is indicative of LCx occlusion (about 10-20% of inferior MIs). Since this is somewhat rare other conditions should be included such as vasospasm, thrombus, or Takotsubo (transient apical wall ballooning). There is no reliable way to exclude MI without a cath so all of those patients will go to the CCL. Following episodes will usually be treated with benzos and rest.

Takotsuo is thought to be caused by catecholamine surge. Think about what happens with cerebral T waves in TBIs or Cocaine induced MIs.


http://ems12lead.com/tag/lcx/

 

[Christopher]

It isn't what you think it is.

Wraparound LAD (just noticed it was Takotsubo, neat) is another possibility. Elevation in II is greater than in III, which likely means it isn't going to be the RCA. LCX seems less likely as aVL has ST-depression. With extension thru I and the anterior leads it is very suspicious for a wraparound LAD.

As for pericarditis, I dunno...aVL/V1/V2 make that a hard sell.

 

[Handsome Robb]

Now I see why you were asking me if I had heard of stress induced cardiomyopathy last night

 

[Brandon O]

Nice case, very classic. Big points are to remember that:

1. Takotsubo's is heart failure, so that's how it looks clinically -- poor cardiac output (someone mentioned pulmonary edema, for instance).
2. Have fun trying, but you're probably not ever going to get truly accurate distinguishing these from the STEMIs, so don't sweat it. The best interpreters in the world send these to be cathed and that's probably how it should be; this is a great mimic and thus an appropriate false-positive.

 

[Aidey]

From the research I've done since this call this EKG seems to be on the...dramatic...end of the Takotsubo's spectrum. Or at least of the EKGs a GIS can find.

 

[325Medic]

I would have called it an Infero-lateral / posterior M.I. also.

F.M.

 

[Brandon O]

From the research I've done since this call this EKG seems to be on the...dramatic...end of the Takotsubo's spectrum. Or at least of the EKGs a GIS can find.

They vary... I've seen some with fairly dramatic inverted T's, bruised-noodle fashion.

 

[VFlutter]

Here is another good example

 

[Merck]

Not that I speak another language but I believe that takotsubo actually means something like 'octupus heart', referring to it's appearance with apical ballooning. Also, this can occur in younger people, more female than male who may present as extremely anxious with chest pain and/or signs of low CO. Interesting differential perhaps for a 30's female with ++anxiety/CP.

 

[Christopher]

Not that I speak another language but I believe that takotsubo actually means something like 'octupus heart', referring to it's appearance with apical ballooning. Also, this can occur in younger people, more female than male who may present as extremely anxious with chest pain and/or signs of low CO. Interesting differential perhaps for a 30's female with ++anxiety/CP.

It's in reference to octopus jars (traps) used by the Japanese.