Cardiovascular/ Pulmonary

Question 1

How is Takotsubo Cardiomyopathy (TCM) and Neurogenic stunned myocardium (NSM) different and similar to each other

Answer 1

TCM: hypokinesis, akinesis or dyskinesis of LV mid segments +\~ apical involvement

NSM: global hypokinesis

Both:
No obstructive coronary disease or ruptured plaque
+ EKG abnormalities: ST elevation/ t wave inversion
No pheochromocytoma or myocarditis

Question 2

How is TCM and NSM different from ACS (Acute coronary syndrome)

Answer 2

Usually people w/o known CAD or new EF < 40%

Wall motion abnormalities don’t correspond with EKG changes

Troponins only mildly elevated (< 2.8)

Question 3

Possible mechanism for NSM or TCM

Answer 3

Excess catecholamines causing:

Transient vasospasm
Micro vascular dysfunction or
Myocyte injury

Also observed in stressful situations

Question 4

Injury to what part of brain associated with prolonged QT interval

Answer 4

Insula cortex

Question 5

Meds known to prolong QT interval

Answer 5

Anti arrhythmia
Anti psychotics
Anti depressants
Abx: erythromycin

And others Table 18.1

Question 6

Prolonged QT interval associated with what dangerous arrhythmia

Answer 6

Torsades de pointes