CHEST Guidelines-A-58-Year-Old-Woman-With-Postoperative-ST-Segment-

A-58-Year-Old-Woman-With-Postoperative-ST-Segment-

Pdf Summary

The article presents the case of a 58-year-old woman who underwent exploratory laparotomy due to small bowel obstruction and was later found with ST segment elevation on an electrocardiogram (ECG). This was concerning due to the potential implication of cardiac stress or myocardial ischemia. Despite the abnormal ECG, the patient was asymptomatic with no chest pain, normal vital signs, and clear auscultation on physical examination. Initial normal troponin levels suggested no acute myocardial infarction.<br /><br />Upon consulting cardiology, the recommendation was to start medications typically used for suspected cardiac issues, including aspirin, beta-blockers, and heparin, while continuing to monitor cardiac enzymes. The use of point-of-care ultrasound (POCUS) revealed a pattern consistent with Takotsubo cardiomyopathy—marked by specific ventricular dysfunctions which are typically without obstructive coronary artery disease.<br /><br />Takotsubo cardiomyopathy, also known as stress-induced cardiomyopathy, is characterized by transient heart dysfunction and can present symptoms akin to acute coronary syndrome, including ischemic ECG changes and elevated cardiac markers. It disproportionately affects women and can lead to myocardial motion abnormalities detectable via echocardiography. In this case, echocardiography results such as left ventricular apical wall hypokinesis and basal segment hyperkinesis confirmed the diagnosis.<br /><br />Despite the initial ECG concerns, coronary angiography indicated non-significant coronary artery disease, further supporting the Takotsubo diagnosis. Following appropriate treatment, the patient's condition improved with resolved left ventricular dysfunction three weeks post-event.<br /><br />This case emphasizes the role of POCUS in differentiating between Takotsubo cardiomyopathy and other acute coronary syndromes, illustrating its clinical utility. The condition highlights the need for careful diagnostic work to differentiate it from more traditional causes of ST segment elevation.

Keywords

Takotsubo cardiomyopathy

ST segment elevation

small bowel obstruction

electrocardiogram

point-of-care ultrasound

cardiac stress

myocardial ischemia

echocardiography

cardiac enzymes

coronary artery disease