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- 78 bpm
- Sinus rhythm
- PR - Normal (~160ms)
- QRS - Normal (80ms)
- ST Elevation leads V2-5 (~1mm)
- Subtle ST elevation leads II, III, aVF, V6
- T wave inversion leads II, III, aVF, V3-6
- Absence of ST depression
- Low voltage P wave with notching in lead II
- Diffuse ST and T wave changes
- Demand ischaemia secondary to sepsis
- Cardiomyopathy - acute vs chronic
- Electrolyte abnormality / Acid-base disturbance
She was admitted under the cardiology team for further investigation of ECG abnormalities with surgical consultation for management of cholecystitis.
The patient had raised cardiac biomarkers and underwent angiography.
The angiogram showed no coronary vessel disease but Takotsubo pattern cardiomyopathy, EF 35-40%. The patient was commenced on beta-blocker, ACE and diuretic therapy and will undergo an elective cholecystectomy once normal cardiac function returns on follow-up echo.
Check out some great cases from Dr Smith's ECG blog on Takotsubo here:
References / Further Reading
Life in the Fast Lane
- Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.