By: Molly Kelly, OMS-IV
A 56 year old woman is rushed to the Emergency Room experiencing chest pains radiating to left arm with shortness of breath. She states the symptoms started suddenly correlating the onset with being scared out of her wits after crossing paths with Dr. Evil while walking home. An EKG shows mild ST elevations and the first set of cardiac enzymes are elevated. The patient is admitted to the ICU where an x-ray study of the coronary arteries and left ventricle with dye is completed demonstrating the absence of severe plaque buildup in a coronary artery as well as an unusual shape of the left ventricle. This distinctive shape is characterized by a narrow upper portion with the lower portion enlarged like a balloon.
What reversible cardiac condition does this patient have?
A.) Myocardial infarction
B.) Takotsubo Cardiomyopathy
C.) Prinzmetal’s Angina
D.) Eccentric Left Ventricular Hypertrophy
A 26 year old woman comes to your office at the behest of her friends as they are concerned with her recent inability to do well at her job as a librarian. They note that their normally shy and reserved friend has been reprimanded for talking too much and too loudly as well as dressing provocatively and giving out her phone number to boys simply checking out books from the library. They note this behavior began after her recent hospitalization for encephalitis. She still does her job well with library operations and easily follows directions but her boss is threatening to fire her if the problems continue.
What medical condition does this patient have validating her friends concern?
A.) Bipolar Disorder
B.) Folie à deux
C.) Histrionic Personality Disorder
D.) Klüver-Bucy Syndrome
Case 1- Takotsubo, or Stress, Cardiomyopathy, also commonly known as “broken heart syndrome,” starts abruptly and unpredictably, with symptoms of chest pain and shortness of breath, usually triggered by an emotionally or physically stressful event, and with a predilection for women older than 50 years of age. Although the basic cause of this condition is unresolved, the frequent association with stress has focused attention on the autonomic nervous system. It has been suggested that when powerful hormones such as adrenaline are released in excess, the heart muscle can be damaged in patients with takotsubo. The shape of the heart, particularly the left ventricle, closely resembles the ceramic Japanese takotsubo pot used to collect an octopus. Because a large proportion of the heart muscle is injured, heart failure can occur. Fortunately, with timely recognition and supportive therapy, takotsubo events are reversible, and recovery is usually rapid and complete. Heart function improves over several days and is usually normal within 7 days.
Case 2- Klüver-Bucy syndrome is a syndrome resulting from bilateral lesions of the amygdala most commonly from herpes simplex encephalitis. It may present with hyperphagia, hypersexuality, hyperorality, and docility. There is no cure for Klüver-Bucy syndrome. The disorder is not life-threatening, but the patient can be difficult to manage. With treatment, symptoms may slowly decline. This may be a difficult diagnosis especially in comparison to answer C with histrionic personality disorder, however, histrionic patients tend to base their symptoms on the need for intimate relationships and there is typically no correlation with illness or injury.