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Takotsubo Cardiomyopathy Following Traumatic Hand Amputation: A Case Report
Bastien H Bacro-Duverger1, Ashley Q Thorburn2, Brad D Denney2
1The University of Alabama at Birmingham, Department of Emergency Medicine, Birmingham, Alabama.
Insights
Stress cardiomyopathy, a form of temporary heart muscle dysfunction, can occur after severe trauma. This case highlights its diagnosis using point-of-care ultrasound in the emergency department following a traumatic hand amputation.
Area of Science:
- Cardiology
- Emergency Medicine
- Trauma Surgery
Background:
- Takotsubo cardiomyopathy, or stress cardiomyopathy, is characterized by transient left ventricular systolic dysfunction.
- It occurs in the absence of obstructive coronary artery disease.
Purpose of the Study:
- To report a case of stress cardiomyopathy diagnosed in the emergency department (ED).
- To highlight the utility of point-of-care ultrasound (POCUS) in diagnosing this condition in the context of trauma.
Main Methods:
- A case report detailing a patient with near-complete traumatic hand amputation.
- Diagnosis of stress cardiomyopathy was made using POCUS in the ED.
- Findings included classic apical ballooning and reduced ejection fraction.
Main Results:
- Point-of-care ultrasonography revealed typical takotsubo cardiomyopathy findings.
- The patient experienced cardiac arrest with rapid return of spontaneous circulation post-trauma.
- The patient recovered and was discharged in stable condition.
Conclusions:
- Stress cardiomyopathy should be considered in patients presenting with acute decompensation after isolated extremity trauma.
- Emergency physicians must be aware of this potential diagnosis in trauma settings.
- POCUS is a valuable tool for rapid diagnosis in the ED.
Introduction:
Takotsubo or stress cardiomyopathy is a syndrome of transient left ventricular systolic dysfunction seen in the absence of obstructive coronary artery disease.
Case Report:
We describe a case of stress cardiomyopathy diagnosed in the emergency department (ED) using point-of-care ultrasound associated with traumatic hand amputation. The patient suffered a near-complete amputation of the right hand while using a circular saw, subsequently complicated by brief cardiac arrest with rapid return of spontaneous circulation. Point-of-care ultrasonography in the ED revealed the classic findings of takotsubo cardiomyopathy, including apical ballooning of the left ventricle and hyperkinesis of the basal walls with a severely reduced ejection fraction. After formalization of the amputation and cardiovascular evaluation, the patient was discharged from the hospital in stable condition 10 days later.
Conclusion:
Emergency physicians should be aware of the possibility of stress cardiomyopathy as a cause for acute decompensation, even in isolated extremity trauma.
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