Author/Authors :
Hans Cativo, Eder Department of Internal Medicine - New York Medical College - Metropolitan Hospital Center, New York, USA , Valvani, Rachna Department of Internal Medicine - New York Medical College - Metropolitan Hospital Center, New York, USA , Mene-Afejuku, Tuoyo O. Department of Internal Medicine - New York Medical College - Metropolitan Hospital Center, New York, USA , Cativo, Diana P. Department of Internal Medicine - New York Medical College - Metropolitan Hospital Center, New York, USA , Mushiyev, Savi Department of Internal Medicine - Cardiology Division - New York Medical College - Metropolitan Hospital Center, New York, USA
Abstract :
Here we present a case of a patient who got trapped in an elevator; on initial evaluation patient was found with bradycardia;
on further evaluation electrocardiogram (EKG) showed new onset 2nd-degree Mobitz type 2 AV block. On admission patient
developed ischemic changes on EKG and troponin elevation. Transthoracic echocardiogram showed reduced ejection fraction
as well as apical inferior, anterior, lateral, and septal hypokinesia. Coronary angiography showed nonobstructive coronary artery
disease and ventriculogram demonstrated anterolateral and apical hypokinesia suggesting takotsubo cardiomyopathy (TCM).
Atrioventricular block (AV) is rarely seen as initial presentation of TCM and has a prevalence of about 2.9%. AV block during
early presentation of TCM poses a therapeutic dilemma with regard to the timing and the need to place a temporary or permanent
pacemaker. The decision to place a permanent pacemaker may be on a case-by-case basis and more research is needed on
formulating standardized recommendations in patients with TCM and conduction tissue abnormalitie
Keywords :
Rare Association , Takotsubo , Cardiomyopathy , High-Degree
