Clinical Case 02

18 Nov

The case

 

A 90 year old male nursing home resident is brought to the ED for because of reduced level of consciousness. He has a background of significant dementia and type II DM.

HR 90

BP150/90

Sats 90RA

RR 22

Temp 36

Patient rousable to physical stimuli only

VBG showed moderate metabolic acidosis with lactate of 10.

ECG is below:

Clinical Case 02 ECG

 

Describe the ECG

There is sinus rhythm with a slightly broad QRS and diffuse ST elevation in a somewhat atypical morphology for STEMI. There are anterior Q waves. 

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A bedside Echo is performed

Describe the appearances

The echo clips are of poor quality and off axis but are sufficient to show apical hypokinesis and ballooning consistent with a Takutsubo Cardiomyopathy.

This is thought of as a stress cardiomyopathy associated with catecholamine release causing ischemia. There should be no coronary occlusion on cardiac cath.

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What happened?

The patient was also suffering from HHS/HONK, had a new renal impairment and a severe pneumonia. He had previously discussed and documented a wish to not have aggressive intervention at the end of life and he was treated with comfort measures.

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Further reading

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