WBR0351

Author	PageAuthor::Neeraja Danda M.B.B.S
Exam Type	ExamType::USMLE Step 2 CK
Main Category	MainCategory::Internal medicine
Sub Category	SubCategory::Cardiovascular
Prompt	[[Prompt::A 52 year old post menopausal woman develops chest pain immediately after a minor earth quake. Electrocardiogram shows ST segment elevation in V1-V4. Troponin is elevated. Echocardiography shows Ballooning of the apex of the left ventricle. Coronary angiogram shows normal coronary arteries even after Ergonovine provocation test. What is the diagnosis of patient’s condition?]]
Answer A	AnswerA::Prinzmetals angina
Answer A Explanation	AnswerAExp::''' Incorrect''' Prinzmetals angina is caused by coronary vasospasm , if the patient is not in active pain ergonovine provocative test is performed which will demonstrate vasospasm
Answer B	AnswerB::Acute myocardial infarction
Answer B Explanation	AnswerBExp::'''Incorrect''' Acute myocardial infarction is due to decreased blood supply to particular coronary wall. Angiography would reveal an occlusive thrombus or critical stenosis limiting flood of blood to the myocardium .
Answer C	AnswerC::Takotsubo Cardiomyopathy
Answer C Explanation	[[AnswerCExp::Takotsubo cardiomyopathy is mostly seen in post menopausal women after a stressful event like earthquake, lightening strike, sudden bad news etc. Angiography will demonstrate patent coronary arteries which do not show vasospasm even on ergonovine provocative test.]]
Answer D	AnswerD::Anxiety
Answer D Explanation	AnswerDExp::'''Incorrect''' Anxiety does not cause ST segment elevation and does not raise cardiac enzymes
Answer E	AnswerE::Acute Pericarditis
Answer E Explanation	AnswerEExp::'''Incorrect''' Acute pericarditis presents with diffuse ST segment elevation and chest pain that changes with position and respiration. Pericarditis would not show ballooning of the apex of the left ventricle on echocardiography.
Right Answer	RightAnswer::C
Explanation	[[Explanation::Takotsubo cardiomyopathy is mostly seen in post menopausal women after a stressful event like earthquake, lightening strike, sudden bad news etc. It leads to ballooning of apex of the left ventricle and alters its contraction ability. Electrocardiogram often shows changes consistent with an anterior wall MI including ST segment elevation.Cardiac enzymes such as troponin may be elevated as well. In contrast to ischemic myocardial infarctions, angiography will demonstrate patent coronary arteries which do not show vasospasm even on ergonovine provocative test. These patients are best managed with Beta blockers and angiotensin converting enzyme inhibitors. Educational Objective : Takotsubo cardiomyopathy (also known as broken heart syndrome) is mostly seen in post menopausal women after a stressful event like earthquake, lightening strike, sudden bad news etc. It leads to ballooning of apex of the left ventricle and alters its contraction ability. Electrocardiogram may show ST segment elevation and troponin might be elevated. But Coronary arteries are normal and do not show vasospasm even upon ergonovine provocative test. References : Page 52 , 54 6Master the boards Step 2 CK second edition, Page 169 Master the boards step 3 2009 edition Educational Objective: References: ]]
Approved	Approved::Yes
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