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


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. 


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.



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.

Further reading


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