Stress cardiomyopathy of the critically ill: Spectrum of secondary, global, probable and subclinical forms

Stress cardiomyopathy (SC) typically presents as potential acute coronary syndrome (ACS) in previously healthy people. While there may be physical or mental stressors, the initial symptom is usually chest pain. This form conforms to the published Mayo diagnostic criteria, is well reported and as the presentation is initially cardiac, is considered primary SC. Increasingly we see SC develop several days into the hospitalization secondary to medical or surgical critical illness. This condition is more complex, presents atypically, is not easy to recognize and carries a much worse prognosis. Label of Secondary SC is appropriate as it manifests in sicker hospitalized patients with numerous comorbidities. We review the limited but provocative literature pertinent to SC in the critically ill and describe important clues to identify global, subclinical and probable forms of SC. We illustrate the several unique clinical features, demographic differences and propose a diagnostic algorithm to optimize cardiac care in the critically ill.

Massive left atrial appendage aneurysm presenting as supraventricular tachycardia.

Left atrial appendage aneurysm is a rarely reported condition. Symptoms are absent in childhood and diagnosis is usually incidental. Systemic embolization or arrhythmia can bring these cases to medical attention. We report the case of a 12-year-old male with massive left atrial appendage aneurysm who presented with effort intolerance and supraventricular arrhythmia. The diagnosis was made by transthoracic echocardiography. Magnetic resonance imaging and left atriogram were also done before surgical resection.