Syncope on the Ward

A 70yo female was a metcall on the ward for syncope while visiting a relative. She had normal obs. Nil CP.

ECG revealed SR, normal QRS and axis, but deep TWI chest and limb leads and 1mm ST dep I and II and V5-6.

PLAx

A4C

Subxyphoid

So the echo clips show good contractility at the base of the heart (first two arrows) and poor contractility and ballooning at the apex (second two arrows). This is typical of Takatsubo. In a patient with ST elevation, chest pain or APO, cardiology may still do a angiogram. However, in this patient, given she had no CP and a classic echo, she was managed symptomatically and recovered well.