69-year-old woman who presented with chest pain and diffuse ST segment elevation on electrocardiogram. Cardiac Enzymes were moderately elevated. Coronary angiography revealed normal coronary arteries.

In the Picture attached is the End-diastolic (A) and end-systolic (B) frames from a left ventriculogram.

What's the Diagnosis?

really i do not know how to read the echo ,, but from these info.

it is Pericarditis

thanks for sharing dr. samir.. keep on please

Dear Luay, in pericarditis you wont have elevated cardiac enzymes and more importantly you wont get this ventriculogram.

but what about the diffuse ST elevation??

then can you tell me what are shown in the ventriculogram. ????

myocarditis may cause elevated cardiac enzymes mo?

I think it is diffuse myocarditis ...
Can anybody explain those pictures to me?
i donnu what are they!

this is myocarditis

(though not sure) i see after the end of systole a lot of blood is left in the left ventricle i.e. impaired contraction

given the myocarditis above my Dx would be post myocarditis dilated cardiomyopathy

please do correct me if im wrong and i would appreciate it if someone can tell me more about the left ventriculogram.


regards

Hey guys, its not Myocarditis, the Endomyocardial biopsy findings in this condition ranged from no evidence of myocarditis to evidence of inflammation. But myocarditis is one of the mechanisms that is postulated to cause this condition.

In the pictures, is a catheter inside the left ventricle giving a material inside the left ventricle and visualized on a screen, one picture shows the lumen of the left ventricle at the end of Diastole which is normal, and the other shows it at the end of Systole which shows a large area of the left ventricle not contracting.

HOPE THIS CAN HELP

then we are waiting for the reply
but samer
can you summarize the causes of diffuse ST elevation??

Samer, you're talking here about decreased wall motion which can happen after an infarction. if it's a recent myocardial infarction and the ST elevation is still there then it's an aneurysm complicating the infarction.

When you say 'diffuse' ST elevation, it usually means pericarditis or myocarditis.

Luay, the diffuse ST elevation can happen in the case of a large MI, Myocarditis, Pericarditis, cardiac tissue injury or scar and this case . Pls add if you know more.

Numan, good answer but unfortunately its not it, the angiography revealed normal coronaries, so its not MI, nor post MI Aneurysm.
The suggestion of an aneurysm can hold if its caused by something other than MI like HOCM [especially the Mid Cavity variant], but the patient doesnt have a Hx of HOCM, and there are no indicatives of an obstruction on the Ventriculogram.

The aneurysm of the LV caused by chronic Chaga's disease is more like it since it can cause an apical aneurysm like the one seen, but ECG will often show an abnormality of conduction [arrhythmia like bundle block....] and can show ST-T wave changes, but not ST Elevation. and it usually causes such an aneurysm with a valvular lesion, such as a regurgitation which is not present in this case. How Chaga's disease affects Cardiac enzymes i have no idea??

You guys are focusing on the ECG findings while you should be focusing on the LV akinesia shown in the ventriculogram.

OK its not an aneurysm. Dig deeper guys.

i remember these words from one of the most senior cardiologists in Jordan..( he left to USA also..hhh)

any diffuse ST eelevation is 99% pericarditis...

so ur case samer is one of that of the remaining 1%...

so,

don't be n7s.. we are not in cardiologists forum... merely a fresh graduates...

just joking dude

could it be endocarditis due to some infiltrative process (amyloid, eosinphilic ...etc.)

and the left wall akinesia could be due to fibrosis which will restrict motion?! :huh




regards

walla ani di5it w mada a3ruf afakkir
now i'm thinking like Farah...
yalla Samer give the answer plzzzzzzzzz

This was a case of Stress-induced cardiomyopathy, also called transient left ventricular (LV) apical ballooning, broken heart syndrome, and, in Japan, my favorite naming: takotsubo cardiomyopathy.

It is an increasingly reported syndrome characterized by transient apical left ventricular dysfunction that mimics myocardial infarction, but in the absence of significant coronary artery disease.

Cardiac enzymes are moderately elevated, ECG shows an ST Elevation.

Patients who survive the acute attack will often regain normal myocardial function within 1-2 weeks.

Triggering factors include, physical and emotionsl stress [hence the name; Broken Heart]. it is prevalent in the postmenopausal women.

Lets Keep Grassing,
Cheers.

((takotsubo cardiomyopathy))

hai swalfak!!!!!!!!!!!!!!!

thanks dr.