title: The Role of Early Focused Cardiac Ultrasound in a Not-So-Typical Presentation of Takotsubo Cardiomyopathy: A Case Report.
abstract: BACKGROUND
  Focused cardiac ultrasound (FoCUS) can be extremely helpful in identifying unexpected diagnoses that can significantly alter treatment options. The diagnosis of Takotsubo cardiomyopathy (TCM) may be difficult to identify.
  
  
  METHODS
  We describe a 47-year-old woman who presented to the emergency department (ED) with atypical features of TCM. Her clinical features included being a premenopausal woman with mild chest pain with a lack of identifiable emotional or physical stressors or significant electrocardiographic changes. Initial findings on FoCUS were consistent with TCM, with these findings replicated on repeat bedside echo performed in the ED by the cardiology fellow. A subsequent comprehensive echo showed marked improvement of the TCM pattern within 24 hours. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: TCM may present in younger women or men, without obvious preceding physical or emotional stressors and with nonspecific ECG findings. FoCUS performed in the ED may suggest a diagnosis of TCM in patients with chest pain or dyspnea of uncertain etiology. The performance of FoCUS, as highlighted by this case report, can lead to timely intervention and follow-up of a variety of cardiac conditions.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Bridgeport Hospital, Bridgeport, Connecticut.
authors.forename: Jithin G
authors.initials: JG
authors.lastname: Varghese
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Bridgeport Hospital, Bridgeport, Connecticut.
authors.forename: Qurat-Ul-Ain
authors.initials: QU
authors.lastname: Jelani
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Bridgeport Hospital, Bridgeport, Connecticut.
authors.forename: Stuart
authors.initials: S
authors.lastname: Zarich
authors.affiliation: Department of Emergency Medicine, Bridgeport Hospital, Bridgeport, Connecticut.
authors.forename: Brooks
authors.initials: B
authors.lastname: Walsh
mesh_terms: D002637:Chest Pain / Q000209:etiology; D004417:Dyspnea / Q000209:etiology; D004636:Emergency Service, Hospital / Q000458:organization & administration; D005260:Female; D006801:Humans; D008875:Middle Aged; D054549:Takotsubo Cardiomyopathy / Q000175:diagnosis*; D014463:Ultrasonography / Q000379:methods* / Q000592:standards
keywords: Takotsubo cardiomyopathy; focused cardiac echocardiography; lack of stressors; premenopausal