Thread by @COREIMpodcast

1/ Welcome back to 12-Lead Thursday #MedTwitter !

Let’s get the juices flowing with an EKG! What are the major abnormalities?

2/ Yes, those are inferolateral ST elevations!

And notice the underlying rhythm of atrial fibrillation

3/ Continuing our patient story, the patient was taken emergently to the cath lab where angiography revealed...

Normal coronary arteries!

4/ Here is the patient’s EKG from the next day.

Based on the findings in this EKG, what is on your #ddx?

5/ The deep T waves seen in V4-V6 make us think about:
✅Takotsubo cardiomyopathy
✅Apical variant of hypertrophic cardiomyopathy
✅Ischemia

What is your *most* likely diagnosis at this point?

6/ Again, the three #ddx we're thinking about are:

7/ The progression of these findings clued us in:

☑️ ST elevations on initial presentation
☑️Deep T-wave inversions with QT prolongation
☑️Normalization of EKG
+ the cath to rule out ischemia

It’s Takotsubo cardiomyopathy!

8/ And while the EKG is helpful for Takotsubo, more is needed for the diagnosis:

- transient wall motion abnormalities (apical ballooning and akinesis)
- absence of obstructive coronary disease
- new EKG abnormalities
-absence of pheochromocytoma and myocarditis

9/ Thanks for tuning into this week’s #12LeadThursday. This byte was authored by Dena Hayes MD with edits by Sam Maidman MD and @gregorykatz . Graphics by Ivanna Tang.

See you next time!