RESUMO
In this clinical vignette, we describe an unusual aetiology of shock that was precipitated by the drainage of malignant pericardial effusion. Therapeutic intervention of the patient's cardiac tamponade led to decreased venous pressures, increased external lung mass compression, worsening superior vena cava syndrome, and ultimately haemodynamic compromise leading to his expiration.
RESUMO
Background: Takotsubo Cardiomyopathy (TTC) is characterized by reversible left ventricular apical ballooning in the absence of angiographically significant coronary artery disease. While TTC is usually preceded by an emotionally stressful event, physical trauma has been documented as a precipitating incident as well. Case summary: An 82-year-old female with no past medical history, presented to the emergency department following a motor vehicle collision. Trauma workup was significant for an ulnar fracture, elevated cardiac enzymes, and ST-segment changes. Bedside echocardiogram revealed apical ballooning. She underwent cardiac catheterization, which failed to demonstrate significant coronary artery disease. The patient developed cardiogenic shock and required temporary vasopressor support after failing a trial of intra-aortic balloon pump. Conclusion: Takotsubo Cardiomyopathy is a rare complication of trauma, which presents with signs and symptoms similar to acute coronary syndrome (ACS) but without evidence of obstructive coronary artery disease. Following trauma, signs of ACS in elderly women should raise provider's suspicion for TTC and prompting bedside echocardiography, which can assist with early diagnosis.
RESUMO
Spontaneous spinal epidural hematoma is an extraordinarily rare condition for which there are only a few hundred documented cases, none in relation to cardiac ablation procedures. This case describes a 71-year-old woman who develops lower extremity numbness and weakness due to spontaneous spinal epidural hematoma after an atrial fibrillation ablation. (Level of Difficulty: Intermediate.).
