A 55-year-old woman who has been working as a nursing assistant for 38 years.
The personal history included: allergic to Paracetamol, hypothyroidism, microapnea.
Surgical history included CIN3 and varices of the lower limbs.
The following cardiovascular risk factors were highlighted: Hypercholesterolemia in treatment for 12 years, dyslipidemia, paroxysmal atrial fibrillation reversed in 2012.
There is a history of work conflict with a partner, known and valued by our department of mental disorder in 2005.
It was then recommended to separate the conflicting parties if optimal working conditions could not be ensured.
A change of job was offered, which was rejected by the worker.
The Occupational Risk Service offered him then to start working in assertive coping techniques for the adaptive management of the situation.
In July 2012, a new stressful situation occurred with the partner with whom she remained in conflict.
He came to the emergency room with chest pain, intense crying and dyspnea, which occurs when reporting to his colleagues the stressful life situation that had just happened to him, after conflict with his partner.
Physical examination at admission to the emergency room: TA: 160/110 mmHg.
Dyspnoea.
A biphasic crackling agent was used, resulting in respiratory failure, with an acute respiratory failure rate of 40 and 82%, respectively, and an acute respiratory failure rate of 3.
Two ampoules of intravenous Furosemide are administered, intravenous nitroglycerin infusion is initiated and ventilation with reservoir mask, with clinical improvement of the patient and blood pressure control.
ECG performed on admission: sinus rhythm at 92 bpm, axis deviated to the left, PR 200 msec, HBAI; poor progression of leads in V1-V3 and dubious elevation of ST3-V6 Figure 1.
1.
Chest X-ray: heart failure.
Transthoracic echocardiography: spherical left ventricle with septal akinesia, hypokinesia of the middle segment of the lower face and LVEF estimated around 20-25% and mild MI.
With the suspicion of Sd.
From takotsubo, transient apical dyskinesia with no increase in enzymatic value, 300 mg of ASA and 600 of clopidogrel were administered and the patient was transferred to the catheterization laboratory for coronary angiography.
This is performed via the left femoral artery and there is no evidence of angiographically significant lesions, although the AD shows a flow pattern I. Ventriculography shows an ovoid LV with LVEF of 25% and allokinesis in the basal segment.
1.
The patient remains hemodynamically stable and asymptomatic for 4 days in the CUOR (Coronary Diseases).
In the last echocardiogram performed during admission, an LVEF 75% is obtained, the rest of the tests performed are normal, so the patient is discharged.
The Occupational Service confirms the emotional triggers of work origin and discards other extra work factors.
Once the contingency determination of the process was assessed, it would finally be recognized as a work accident.
