Jump to content


Photo
* * * * - 1 votes

Case #34 Young + Ami = ?


  • Please log in to reply
62 replies to this topic

#61 EDMEDIC

EDMEDIC

    Advanced Member

  • Members
  • PipPipPip
  • 94 posts

Posted 30 July 2009 - 01:10 PM

Hi all, great case. I'm on vacation and just got a chance to look at this one. I haven't been lurking, just not doing anything on the net other thanlooking at today's weather and tide tables!..I thought of ASD /p looking at the echo. I must admit, though, that I couldn't come up /c a definitave answer or Dx. I learned a lot from this bunch of practioners! Thanx again, Brian
  • 0
Brian EMT-P/CC
"failing to prepare is preparing to fail"
" you don't know what you don't know"

#62 wwohl

wwohl

    Newbie

  • Members
  • Pip
  • 1 posts

Posted 15 October 2009 - 01:43 AM

Well since this old case got dug up... actually just learned about this just recently.. Once i saw the combination of SOB, CP, wet lungs, HTN, and significant anxiety without a STEMI ECG, i was immediatley thinking "broken heart syndrome".. I actually just found out about this recently. There was a Pt in the local ER where my mom is an RN who was telling me about this case..

Here is some good info:
In the Hopkins study, to be published in The New England Journal of Medicine online Feb. 10, the research team found that some people may respond to sudden, overwhelming emotional stress by releasing large amounts of catecholamines (notably adrenalin and noradrenalin, also called epinephrine and norepinephrine) into the blood stream, along with their breakdown products and small proteins produced by an excited nervous system. These chemicals can be temporarily toxic to the heart, effectively stunning the muscle and producing symptoms similar to a typical heart attack, including chest pain, fluid in the lungs, shortness of breath and heart failure.

Upon closer examination, though, the researchers determined that cases of stress cardiomyopathy were clinically very different from a typical heart attack.

“After observing several cases of ‘broken heart’ syndrome at Hopkins hospitals - most of them in middle-aged or elderly women - we realized that these patients had clinical features quite different from typical cases of heart attack, and that something very different was happening,” says Wittstein. “These cases were, initially, difficult to explain because most of the patients were previously healthy and had few risk factors for heart disease.”

For example, examination by angiogram showed no blockages in the arteries supplying the heart. Blood tests also failed to reveal some typical signs of a heart attack, such as highly elevated levels of cardiac enzymes that are released into the blood stream from damaged heart muscle. Magnetic resonance imaging (MRI) scans confirmed that none of the stressed patients had suffered irreversible muscle damage. Of greatest surprise, the team says, was that recovery rates were much faster than typically seen after a heart attack. Stressed patients showed dramatic improvement in their hearts’ ability to pump within a few days and had complete recovery within two weeks. In contrast, partial recovery after a heart attack can take weeks or months and, frequently, the heart muscle damage is permanent.

http://www.hopkinsme...5/02_10_05.html

bill
  • 0
B.Wohl NREMTP

#63 Sue

Sue

    Advanced Member

  • Members
  • PipPipPip
  • 62 posts

Posted 15 October 2009 - 01:35 PM

Well since this old case got dug up... actually just learned about this just recently.. Once i saw the combination of SOB, CP, wet lungs, HTN, and significant anxiety without a STEMI ECG, i was immediatley thinking "broken heart syndrome".. I actually just found out about this recently. There was a Pt in the local ER where my mom is an RN who was telling me about this case..

Here is some good info:
In the Hopkins study, to be published in The New England Journal of Medicine online Feb. 10, the research team found that some people may respond to sudden, overwhelming emotional stress by releasing large amounts of catecholamines (notably adrenalin and noradrenalin, also called epinephrine and norepinephrine) into the blood stream, along with their breakdown products and small proteins produced by an excited nervous system. These chemicals can be temporarily toxic to the heart, effectively stunning the muscle and producing symptoms similar to a typical heart attack, including chest pain, fluid in the lungs, shortness of breath and heart failure.

Upon closer examination, though, the researchers determined that cases of stress cardiomyopathy were clinically very different from a typical heart attack.

“After observing several cases of ‘broken heart’ syndrome at Hopkins hospitals - most of them in middle-aged or elderly women - we realized that these patients had clinical features quite different from typical cases of heart attack, and that something very different was happening,” says Wittstein. “These cases were, initially, difficult to explain because most of the patients were previously healthy and had few risk factors for heart disease.”

For example, examination by angiogram showed no blockages in the arteries supplying the heart. Blood tests also failed to reveal some typical signs of a heart attack, such as highly elevated levels of cardiac enzymes that are released into the blood stream from damaged heart muscle. Magnetic resonance imaging (MRI) scans confirmed that none of the stressed patients had suffered irreversible muscle damage. Of greatest surprise, the team says, was that recovery rates were much faster than typically seen after a heart attack. Stressed patients showed dramatic improvement in their hearts’ ability to pump within a few days and had complete recovery within two weeks. In contrast, partial recovery after a heart attack can take weeks or months and, frequently, the heart muscle damage is permanent.

http://www.hopkinsme...5/02_10_05.html

bill


There is also an awesome article in this months Critical Care Nursing journal on Takutsobo Cardiomyopathy, also known as "Broken Heart Syndrome" if anyone is interested.

Sue
  • 0


Sue Toberman, RN