Thursday, November 04, 2010

STEMI criteria, STEMI equivalents and Takotsubo cardiomyopathy

There's a great case discussion over at the 12 lead ECG blog. The patient, while not meeting the official criteria for STEMI, had tell-tale electrocardiographic signs of acute coronary occlusion (what I'm calling STEMI equivalent these days). The blogger gives a brilliant discussion of the findings. Then when the patient actually turned out to have Takotsubo cardiomyopathy he provides an equally brilliant discussion of that entity. Go read the entire three part post which ends with the link above.

By the way Takotsubo cardiomyopathy, while originally presented as a cardiomyopathy that followed well defined emotional stress, is now being described in a wider variety of settings, including patients admitted with other diagnoses, in which, presumably, the initial non-cardiac diagnosis is the triggering stress. See, for example, this review. It may even be a factor in some patients experiencing the well known “cardiopathy of sepsis” in which patients with severe sepsis experience troponin bumps and drop their ejection fractions transiently. Because it's identified with increasing frequency and is soooo cool to diagnose I wonder if it's on a trajectory from under appreciated entity to wastebasket diagnosis for any cardiomyopathy when the clinician doesn't know what else to call it.

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