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Challenges in Clinical Electrocardiography
May 2015

Takotsubo CardiomyopathyHow T Waves Behave Under Stress

Author Affiliations
  • 1Department of Internal Medicine, University of California, San Francisco
  • 2Division of Cardiology, Department of Internal Medicine, San Francisco General Hospital, San Francisco, California
JAMA Intern Med. 2015;175(5):842-844. doi:10.1001/jamainternmed.2015.52

A woman in her 60s with hypertension and hyperlipidemia presented with chest pain for 3 days. She denied any cardiac history but reported intermittent substernal chest pain for the past few months that had worsened in the past week. She denied associated symptoms. Her vital signs and cardiopulmonary examination results were within normal limits; her baseline electrocardiogram (ECG) is shown in Figure 1. Initial troponin level was 0.33 µg/L. Her chest pain resolved after administration of sublingual nitroglycerin, and her troponin level decreased to 0.1 µg/L. Given the patient’s elevated cardiac enzymes, she was admitted for treatment of non-ST elevation myocardial infarction. Twelve hours after admission, the patient had another episode of substernal chest pain with troponin elevation to 0.3 µg/L. An ECG recorded at that time is shown in Figure 2. She was treated with nitrates, and her chest pain resolved. Another ECG was obtained after her pain resolved and her subsequent troponin measurements trended down (Figure 3).

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