Critical Care Scenarios Episode 2: Takotsubo (Stress) Cardiomyopathy
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Jan 1, 2020 The hosts dive into a complex case of a 65-year-old woman battling severe sepsis in the ICU. They tackle the intricate evaluation of her hypoxia and hypotension, discussing potential cardiac issues and treatment strategies. The management of ventilated septic patients highlights the importance of respiratory support and targeted antibiotics. A deep dive into Takotsubo cardiomyopathy unveils its diagnostic challenges and treatment options, emphasizing the need for thorough ultrasound assessments and appropriate pharmacological interventions.
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Initial Case Presentation And Echo Finding
- The team presents a 65-year-old woman with a week of cough, hypoxia, and borderline hypotension who worsens despite fluids.
- Point-of-care ultrasound then reveals apical LV akinesis with diffuse lung B-lines, shifting the differential toward stress cardiomyopathy.
Assume STEMI Until Proven Otherwise
- Treat widespread ST elevation as ischemic until you can definitively rule out an acute coronary occlusion.
- Activate cardiology/cath lab promptly while supporting the patient hemodynamically and preparing for airway management if needed.
Lab And Cath Pattern In Takotsubo
- Takotsubo often presents with modest troponin rise and very high BNP, and bedside echo can be diagnostic.
- Coronary angiography will be clean, confirming stress cardiomyopathy rather than obstructive MI.