Open AccessThe importance of systematic point‐of‐care ultrasound for chest pain with ST‐segment elevation: A case report of takotsubo cardiomyopathy precipitated by spontaneous pneumothorax
Author(s) -
Kim YoonSeop,
Cha Yong Sung
Publication year - 2021
Publication title -
hong kong journal of emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.145
H-Index - 12
eISSN - 2309-5407
pISSN - 1024-9079
DOI - 10.1177/1024907919893790
Subject(s) - medicine , chest pain , cardiology , pneumothorax , cardiomyopathy , myocardial infarction , st segment , emergency department , st elevation , etiology , radiology , heart failure , psychiatry
Patients with chest pain and concomitant ST‐segment elevation on an electrocardiogram should be identified as having suspected ST‐segment elevation myocardial infarction. However, various etiologies cause ST‐segment elevation other than ST‐segment elevation myocardial infarction, such as takotsubo cardiomyopathy. Case presentation: Here we report the case of a 77‐year‐old man who requested transport by helicopter emergency medical service for ST‐segment elevation myocardial infarction but was consequently diagnosed with takotsubo cardiomyopathy due to spontaneous pneumothorax. En route, findings of electrocardiogram as well as focused cardiac point‐of‐care ultrasound could not distinguish takotsubo cardiomyopathy from ST‐segment elevation myocardial infarction, but a subsequent point‐of‐care ultrasound could reveal occult pneumothorax, which ultimately revealed to be the culprit stress factor of takotsubo cardiomyopathy causing ST‐segment elevation myocardial infarction–alike presentation. After treatment with a closed thoracostomy, he recovered from the takotsubo cardiomyopathy and pneumothorax and was discharged without any complications. Discussion and conclusion: We should consider takotsubo cardiomyopathy a disease with ST‐segment elevation and spontaneous pneumothorax as one of its precipitating stressors. To clarify the diagnosis, point‐of‐care ultrasound using a systematic rather than region‐of‐interest approach may be a useful method in the emergency department.