Department of Medicine, Shri Aurobindo Institute of Medical Sciences, Indore, Madhya Pradesh, India
Department of Medicine, Shri Aurobindo Institute of Medical Sciences, Indore, Madhya Pradesh
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Joshi P. Author's reply.J Postgrad Med 2013;59:337-338
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Joshi P. Author's reply. J Postgrad Med [serial online] 2013 [cited 2021 Apr 13 ];59:337-338
Available from: https://www.jpgmonline.com/text.asp?2013/59/4/337/123184
Thank you for your comments.  We did think of Takotsubo cardiomyopathy (TCC) in the differential diagnosis.
TCC or apical ballooning syndrome is a clinical entity mimicking acute coronary syndrome. It occurs mostly in women, postmenopausal, elderly and this accounts for 90% of cases in most case series.  The most common symptom is chest pain at rest though some patients can have dyspnea. The Electrocardiogram (ECG) findings is of mild ST segment elevation in 50-60% patients, but nonspecific ST-T changes can also be present and these changes resolve with deep T wave inversion.  Troponin levels are only mildly elevated and two-dimensional (2D) echocardiography shows wall motion abnormality which extends beyond the distribution of any one single coronary artery. Patients with this disorder present in the emergency department with all these features and do not subsequently develop it over the course of time.
Our patient was a middle age male who presented with symptoms and signs of organophosphorus poisoning. At presentation there was no chest pain or dyspnea and the ECG was normal. 2D echocardiography was suggestive of involvement of a single coronary artery. Troponin values were significantly raised and subsequent ECG did not show deep T inversion. With these in mind, it is unlikely that this patient might be suffering from TCC. Coronary angiography is diagnostic of this condition which shows absence of obstructive coronary artery disease. This was not done in our case due to financial constraints.
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