a frequent basis. Due to the imaging findings and new onset hypoxia, an ILD and autoimmune workup was started. Labs resulted with a positive ANA and Anti-SSA antibodies. Bronchoscopy was performed and studies were sent for further evaluation. She was empirically started on prednisone 40 mg post bronchoscopy which improved her symptoms. Discussion: Sjogren’s syndrome is classically associated with lymphocytic interstitial pneumonia and cystic lung disease, but the most common type of ILD in Sjogren’s patients is nonspecific
interstitial pneumonia, which carries a more favorable prognosis. In addition to the inflammation and scarring typically seen in all ILDs, patients with Sjögren’s can develop cysts that can predispose them to experience pneumothorax. In SjS both the sublingual and submandibular glands are affected causing their destruction which decreases production of saliva. Saliva is crucial in maintaining oral health and protecting against bacteria. Rapid detection and treatment of Sjogren’s can prevent its systemic progression.
A BROKEN, SPASTIC HEART: CASE OF TAKOTSUBO CARDIOMYOPATHY COMPLICATED BY VASOSPASTIC ANGINA. Ahmed Fazal-ur-Rehman, Yazan Alqara MD, Sathwik Billa MD, Chetan Surakanti MS4, Gregory Ardoin MD; Louisiana State University, Lafayette, LA.
Introduction: Takotsubo Cardiomyopathy, or broken-heart syndrome, is a form of non-ischemic cardiomyopathy that is characterized by transient apical dyskinesia and reversible left ventricular dysfunction, usually triggered by an acute stressor, most commonly with physical and/or emotional distress. In recent years, Takotsubo Cardiomyopathy has been found to be associated with sudden death, myocardial infarction, and congestive heart failure. Vasospastic angina is commonly associated with cocaine or heavy cigarette use. Findings associated with vasospastic angina include chronic pattern of episodic chest pain at rest lasting 5-15 minutes, ST segment changes on the electrocardiogram (EKG) during episodes, no exacerbating factors, pain resolution with anti- anginals, and minimal risk factors for cardiac disease. Case: A female in her early 60’s with a 30 pack- year tobacco history and no other medical history presented with a two-week history of recurrent, episodic midsternal chest pain radiating into the left arm and jaw, associated with diaphoresis, tachycardia, eructation, and flatulence. Episodes occurred initially 2-3 times per day, lasting 5 minutes, and were exacerbated by anxiety/stress or post- prandially. Of note, the patient’s ex-husband recently
passed away. Prior to presentation, the patient had unremarkable cardiac and intraabdominal workups including a CT of the abdomen and pelvis, esophagogastrodudenoscopy, gallbladder ultrasound, and coronary angiogram. EKG and cardiac enzymes were concerning for a non-ST elevation myocardial infarction. Dual antiplatelet therapy and a heparin drip were initiated. A echocardiogram revealed findings suggestive of Takotsubo Cardiomyopathy. Her clinical course was suggestive of vasospastic angina resolved with nitrate and calcium channel blocker therapy. Discussion: This case demonstrates how multiple cardiac pathologies can present together, despite their individual rarity. The patient presented with anginal symptoms but was found to have a negative coronary angiogram shortly before presentation. In this case, EKG findings, elevated troponin, and associated symptoms were likely due to causes other than acute coronary syndrome (ACS). Recognition of Takotsubo cardiomyopathy and vasospastic angina is important due to their differences in treatment from ACS. These conditions may present together as in this case. ACS must be excluded prior to diagnosing these conditions to minimize mortality.
17
Made with FlippingBook Digital Publishing Software