Transcript

 - So this is a 45 year old woman who had a robotic hysterectomy. She did fine with the operation, but then that evening she developed chest pain and got critically ill. Her lungs filled up with water, she had to be put on a breathing machine and her heart stopped working. There was evidence of myocardial injury with a markedly elevated troponin. An echocardiogram showed that the ejection fraction had fallen down to 10%, normal being 60. She went into what we call cardiogenic shock, meaning that her heart can no longer perform the functions it needed. She was taken for an urgent cardio catheterization. There were no blockages in her coronary arteries. They inserted an intraaortic balloon pump and she got urgently transferred to our medical center. Upon arrival, we spoke with her husband and we learned that three years ago, his wife had a episode of chest pain, went to an outside emergency room, had evidence of myocardial injury by blood tests, was taken for an urgent catheterization showing no blockages in her coronary arteries and she was diagnosed with coronary invasive spasm. This happened the second time, which was two years prior to this submission where she had a upper respiratory infection, became acutely short of breath, again was told that her heart was weak and this time she was diagnosed with myocarditis. When she arrived at our hospital, she was critically ill, on the balloon pump, on the ventilator and was in clear cardiogenic shock. She had evidence of acute renal failure, normal craning being one, hers was five, and an evidence of shocked liver. So what do you think's wrong with her? What's your diagnosis?