Case report: Unmasking a myocardial infarction mimicker: A case report of Takotsubo cardiomyopathy in a patient with intestinal obstruction
Tóm tắt
Background
The association of ischemic changes on ECG and troponin elevation with angina or anginal equivalent is frequently diagnosed as acute coronary syndrome (ACS). However, it is important to consider conditions other than ACS that may present similar features as the difference in the treatment is substantial. We report a case of an elderly female who presented with an ACS mimicker in the setting of an intestinal obstruction.
Results
A previously well 64-year old female presented to the emergency department due to 2-day history of epigastric discomfort associated with ischemic changes on ECG and cardiac troponin elevation. She was diagnosed with acute coronary syndrome and was managed with dual antiplatelets and anticoagulant. However, upon re-assessment, her signs and symptoms were more compatible with intestinal obstruction and the 2dechocardiogram showed wall motion abnormalities consistent with apical ballooning. Computed tomography scan of the abdomen showed dilated bowel loops due to volvulus in the jejunum and inflammation of the appendix with surrounding periappendiceal abscess. Multidisciplinary discussion with a gastroenterologist and colorectal surgeon was made due to need for surgical intervention in the setting of a high risk for perioperative cardiac events. Emergency exploratory laparotomy was done under intraoperative cardiac monitoring. After a moderately stormy immediate post-operative course, patient was extubated on the 2nd post-operative day and started on oral beta-blockers and angiotensin-receptor blocker. There were no remaining complications during the rest of the hospital stay. A CT coronary angiogram done after discharge showed patent coronary arteries with a total calcium score of 0.
Conclusion
Takostubo syndrome can highly mimic an ACS, hence It is essential that a thorough and carefully organized patient history is obtained to avoid delays in the management of the underlying illness that triggered TS, particularly when the definitive therapy is surgical in nature.
