A 77-year-old woman with a history of arterial hypertension treated with carvedyl and dyslipidemia, who consulted for the first time in April 2004 for a retro-strength depressive episode, unusual stress for her 20 blocks.
He was hospitalized in the Coronary Unit 6 hours after the onset of symptoms.
On admission tests she presented: Electrocardiogram (ECG) with symmetrical inversion of T wave in VI-V6, troponine ( Troponin) (0,00-T 0,5-16MB), total CK 163 ng/mL-115)
She was treated for non-ST elevation AMI.
The next day a cardiogram showed severe left ventricular systolic dysfunction and extensive anteoseptoapical akinesia, with an ejection fraction of 35%.
Coronary angiography showed no significant angiographic lesions, and transient left ventricular systolic dysfunction (stress cardiomyopathy) was diagnosed.
The patient recovered satisfactorily, with T wave regression, transient prolongation of QTc interval and decrease of cardiac serum markers.
She was stable and asymptomatic.
In 2006, on an outpatient basis, a control echocardiogram was performed, which revealed global and segmental motility of the preserved left ventricle and ejection fraction of 60%.
On February 27, 2010, in the city of Santiago, the patient began with severe angina at rest, with marked neurovegetative symptoms at 3:40 AM, immediately after the earthquake.
Located to Emergency Service at 5:45 AM.
On admission, the patient was hypertensive and hypertensive.
The ECG showed ST-segment elevation at V1-V3, troponin T 0.184 ng/mL, total CK 118 ng/mL and CK-MB 18.4 ng/mL.
It was decided to perform thrombolysis with 1.500,000 IU intravenous streptokinase in 45 minutes, a procedure without incidents.
The patient was admitted without angina, in Killip class I, with progressive decrease of cardiac enzymes.
Forty-eight hours after the initial event, an echocardiogram revealed a left ventricle slightly dilated in systole with moderate reduction in global motility due to septoapical and lateral akinesia, with an estimated ejection fraction of 35%.
Subsequently, coronary angiography was performed, which did not reveal significant angiographic lesions, and the ventricle scintigraphy showed ballooning of the apical segments of the left ventricle with an estimated ejection fraction of 40%.
The electrocardiogram prior to discharge showed no signs of ischemia.
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The patient was discharged 5 days after admission with carvedilol, aspirin, plavix, atorvastatin and enalapril permanently.
On June 18, 2010, a control echocardiogram showed an estimated ejection fraction of 66% and left atrial fibrillation.
