ABSTRACT
Takotsubo cardiomyopathy (TCMP) is an important, though under-recognised, syndrome which mimics acute coronary syndrome (ACS) presenting with similar clinical, biochemical and ECG features. A 68-year-old man was referred as ACS for emergency coronary angiography; however, a history of lethargy, weight loss and electrolyte abnormalities prompted further investigations. Angiography was postponed, adrenal insufficiency confirmed and steroid replacement commenced. Echocardiography demonstrated reduced left ventricular (LV) function (45%) with regional wall motion abnormalities, although angiography confirmed unobstructed arteries. Steroid replacement induced a rapid improvement in symptoms and LV function. Few cases of TCMP associated with adrenal insufficiency have been reported. This appears to be the first case describing TCMP precipitated by new-onset secondary adrenal insufficiency following long-term steroid use in a male patient, and highlights the importance of considering TCMP in patients presenting with suspected ACS. Here, prompt recognition and treatment of a serious underlying disorder prevented a potentially life-threatening Addisonian crisis.
Subject(s)
Acute Coronary Syndrome/diagnosis , Adrenal Insufficiency/diagnosis , Takotsubo Cardiomyopathy/diagnosis , Adrenal Cortex Function Tests , Adrenal Insufficiency/chemically induced , Adrenal Insufficiency/complications , Adrenal Insufficiency/drug therapy , Aged , Asthma/drug therapy , C-Reactive Protein/metabolism , Diagnosis, Differential , Echocardiography , Eczema/drug therapy , Electrocardiography , Glucocorticoids/adverse effects , Hormone Replacement Therapy , Humans , Hydrocortisone/therapeutic use , Hyperkalemia/etiology , Hyponatremia/etiology , Male , Pneumonia/complications , Pneumonia/diagnosis , Takotsubo Cardiomyopathy/complicationsABSTRACT
We present a case of acute aortic homograft regurgitation manifesting as a new-onset "cooing" murmur in a patient with congenital heart disease who did not have signs of clinical decompensation or evidence of infective endocarditis. He underwent successful transcatheter aortic valve implantation following a diagnosis of sterile acute valvular degeneration. (Level of Difficulty: Intermediate.).
ABSTRACT
With the expected nursing shortfall, uncertain economy, and projected increase in volume of persons requiring healthcare, the current models of care delivery cannot be sustained. New delivery models are necessary to maximize nurses' knowledge, expertise, and time. The authors describe the use of computer simulation using principles of Lean to help design a care delivery model with an enhanced role for the professional nurse.