PMC5394412_01
EKG showed atrial fibrillation with rapid ventricular response as well as ST elevations in leads II, III, aVF, and V3-V6.
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EKG showed atrial fibrillation with rapid ventricular response as well as ST elevations in leads II, III, aVF, and V3-V6 (Figure 1).
(a) and (b): cardiac catheterization on day of admission revealing no obstructive coronary artery disease in RCA and LAD, respectively.
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Emergent coronary angiography demonstrated normal coronaries (Figures 2(a) and 2(b)) with anterolateral, apical, and inferoapical dyskinesis and basal anterior and basal inferior wall hyperkinesis; ejection fraction (EF) was 20%.
(a) and (b): echocardiogram on day of admission showing the apical ballooning typical of TC in systole and diastole, respectively.
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Findings were consistent with TC (Figures 3(a) and 3(b)).
(a) and (b): patient's baseline echo showing asymmetric septal hypertrophy in systole and diastole, respectively.
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When examining an old echocardiogram, patient had documented asymmetric septal hypertrophy, systolic anterior motion of mitral valve, and an intraventricular gradient of 32 mmhg with an EF of 75% (Figures 4(a) and 4(b)).
Glucose level since diagnosis of DKA.
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Diabetic Ketoacidosis (DKA) in setting of new and acute cardiomyopathy, moderate hydration was started to avoid risk of pulmonary overload. DKA was controlled by day 4 of hospital stay (Figure 5) and repeat echo on day 5 showed documented resolution of apical ballooning.