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- W2977832783 abstract "Purpose: A 56-year-old African American female presented to the ER with complaints of bright red blood per rectum (BRBPR) for two days. The patient had four episodes of BRBPR, around one small bowl in quantity each. On physical exam, the abdomen was soft, non-tender and non-distended and the rectal exam revealed non-thrombosed external hemorrhoids. While in the ER, patient developed a pressure like substernal chest pain. An EKG was done which showed ST segment elevations in leads II, III, aVF and leads V2-V6. The lab work showed no significant drop in hematocrit, but a marked elevation in cardiac enzymes (CK-MB - 78.6 ng/ml, Troponin I - 42.3 ng/ml). The patient was rushed for an urgent cardiac catheterization which showed normal coronary arteries but the left ventriculogram revealed a hypercontractile basal wall and apical ballooning in systole, consistent with the diagnosis of Broken Heart Syndrome (Figure A). The patient was admitted to CCU for observation and had a complete recovery in one week. An eventual colonoscopy revealed internal hemorrhoids to be the source of BRBPR. Broken Heart Syndrome, also known as Takotsubo Cardiomyopathy or Apical Ballooning Syndrome, was first described in Japan in 1990. It presents similarly to an acute MI with patients having chest pain, ST segment elevations and elevated cardiac enzymes but the cardiac catheterization reveals normal coronaries. The appearance of heart on the left ventriculogram mimics the shape of a “Takotsubo” - an octopus trap, and hence the name. Broken Heart Syndrome mostly affects post-menopausal women and is classically triggered by either an acute medical illness or intense emotional stress. Lower Gl bleed was most likely the inciting event in our patient, as she denied any history of recent stress. Previously, cases of Broken Heart Syndrome have been described in association with acute pancreatitis, achalasia, esophageal carcinoma and hepatic encephalopathy but to the best of our knowledge, this is the first reported case after an episode of GI bleed.Figure: [1122] Figure A. Left ventriculogram showing apical ballooning in systole." @default.
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- W2977832783 date "2012-10-01" @default.
- W2977832783 modified "2023-09-23" @default.
- W2977832783 title "Lower GI Bleed and Broken Heart Syndrome" @default.
- W2977832783 doi "https://doi.org/10.14309/00000434-201210001-01122" @default.
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