Feeling Like a Yo-Yo…

We have a new staffing matrix at my Hospital. It doesn’t affect me greatly as I work 2 shifts a week in the Ick-U as a Tele Tech and 1 shift a week on Med-Surg. However, it affects me enough that I’ve been called off every Friday for the last 3 Friday’s (the days I am assigned to work on Med-Surg). The matrix allows for one Nurse and a Unit Secretary up to 5 patient’s. At 6 patient’s the Unit Secretary goes home and the Aide gets called in up until 7 patient’s. At 7 patient’s a second nurse gets called in and the aide gets sent home and placed on call until the unit reaches 11 patient’s, whereby, the aide must come back in. Well, last night Med-Surg had 2 patients, got a patient transferred from the ICU (chest pain and on Tele), and then had a Pediatric admit and a Geriatic admit. This brought us to 5 patients. I was called in at the start of the shift because blood was to be given to two patients and there were additional admits planned. So. When we have low census, I not only play aide, I play Unit Secretary, and back up Tele. It is a very chaotic, unorganized way to work…what I do is vitals, HS cares on one patient and then go back to the Nurse’s station to put in orders, etc. To make matters even worse…after I did HS rounds and midnight vitals, I had to prepare all of the charts for the next day. About 3am we transferred a paitend from Med-Surg to ICU. I had to tear down the Med-Surg chart, breakdown the room (patient had been in ISO for C-Diff), take the patient over to the Ick-U, set up the Ick-U room, put the new ICU chart together, input all of the orders, run Tele strips, and help the patient (who had raging diarrhea)…the patient was not following instructions and being non-compliant with everything so doing a simple maneuver like a pivot transfer to the commode was difficult. I ran my TAIL off!!! I am trying to find the shiny side of the penny, and I am trying to convince myself it is a great matrix that teaches me fantastic time management and organizational skills…but I don’t buy it one minute. We got a shitty matrix because the big-wigs are cutting corners so they all get humongous bonus checks. It was said in a staff meeting that if we as a group could hold on until January, the staffing patterns would go back to normal…we all know what the translation is: “work your current staff beyond belief  so they quit…but only after working enough to meet corporate financial needs and then hire new, inexperienced staff at lower wages.” I’m trying to do what is asked, but it is difficult….to balance the workload, some things get missed. That bugs the hell out of me!

Thanksgiving version 2008…

I think service is very important, but I rarely have the time to give back to my community with the capacity that I desire. So, as a service commitment,  I generally volunteer to work the Holiday’s so that those with children can have time with their family and not have to worry about time parameters or making it to work despite a busy and full day. My service commitment makes my husband commit to that same service endeavor, too..therefore,  we don’t celebrate Holiday’s on their designated day, but a day prior to or after the event. Normally, on the day we designate as our celebratory day, I go all out and cook a very nice, albeit,  traditional meal with a few new recipes added in to make things special. I usually set a nice table for just the two of us and light candles. This year, I am still planning to do that, but it will be 3 weeks after the Holiday due to work and school issues.

The problem I faced was the fact that we still needed to eat today; so, I made chicken fajitas and nachos with a spanish corn and salad on the side. Nothing really fancy. Nothing time consuming. Nothing that would makes us feel gluttonous…and it WAS good. But something was missing….and then I realized it was our tradition of telling each other what we were grateful for. Husband wasn’t in the mood to play…so, here are some of the things I cherish:

1) Having a Husband who allows me to promote a “service” ideology, although it often places him last.

2) Having someone in my life that loves me despite my flaws, selfish moments, and moodiness.

3) Having someone who adores me so much that I am considered beautiful, even though I am only 4′11″ and am not a size 00.

4) Being able to share the experience of life with someone…someone whom I can make laugh and who makes me laugh.

5) Having a wide open heart that offers love to whomever I meet…I really DO look up to everyone.

6) Having the resources to own my home…money-pit that it is.

7) Having a reliable car that allows me to commute 2 hours a day to school.

Being able to find a way to pay for school; and continue my educational endeavors.

9) Having a Spouse who isn’t critical of me, even though I can’t seem to make the first round of educational endeavors work.

10) Having a job that is exciting, interesting, that propels me to be a better human being, that teaches me continually, that allows me to work with brilliant and interetsing people.

11) Having a voice to express my thoughts, feelings, ideas, angst…I am so grateful that I have these and other freedoms.

12) Knowing that I have friends that truly care whether or not I get up in the morning.

13) Having a reason to get up each day.

14) Having the honor of knowing military personnel that fight for the American way; and try to teach its beauty to those in other lands.

15) Having the will to pick myself up, wipe the dust off, and try to progress forward…even after I made a doozy of a mistake.

16) Grateful that I get to ski once a year.

17) Appreciative that I have step-daughters who are amazing; and step grand-children who are treasures.

18) Knowing that even though I may never be a mother in the true sense of the word; I gave life to an incredible woman who means the world to so many people. If I never accomplish anything else in my life of worth. I have done ONE good thing.

There are so many more things I should list because I know I have been given much. What I have learned thus far is that life is not always easy. I believe that trials and tribulations are there so that we may learn the lessons specific to us as individuals…the ones that we need to embrace and learn to help us progress and gain the most wisdom. That is why the journey, for each of us is so vastly different.

Two roads diverged in a yellow wood,

And sorry I could not travel both

And be one traveler, long I stood

And looked down one as far as I could

To where it bent in the undergrowth;

Then took the other, as jus as fair,

And having perhaps the better claim,

Because it was grassy and wanted wear;

Though as for that, the passing there

Had worn them really about the same,

And both that morning equally lay

In leaves no step had trodden black.

Oh, I kept the first for another day!

Yet knowing how way leads on to way,

I doubted if I should ever come back.

I shall be telling this with a sigh

Somewhere  ages and ages hence:

Two roads diverged in a wood, and I –

I took the one less traveled by,

And that has made all the difference.

The Road Less Taken, by poet Robert Frost

The Heart…Truly the Center of the Universe…

Chest pain after emotional and physical upset

P Parulekar, senior house officer, M Z O Khawaja, specialist registrar, E T McWilliams, consultant

¹ Department of Cardiology, Conquest Hospital, St Leonards-on-Sea TN37 7RD

drzeeshan@doctors.org.uk

 

Case history

A 61 year old white woman attended her local accident and emergency department with severe central chest pain. After being chased by two large terrier dogs. The pain was not relieved by nitroglycerine spray given in the ambulance. An electrocardiogram showed anterolateral ST segment depression, with an elevated troponin T of 1.25 µg/l. She had no cardiovascular risk factors. Non-ST elevation myocardial infarction was diagnosed, and the patient was treated accordingly.

Coronary angiography showed normal coronary arteries, but the left ventriculogram showed a large area of apical hypokinesis with moderate impairment of left ventricular systolic function.

The patient was readmitted several weeks later with further chest pain. An electrocardiogram showed no new changes with no rise in the cardiac troponin. An echocardiogram showed that her left ventricular systolic function had almost returned to normal.

 

Questions

 

1. What is the diagnosis?

2. Which patients are most at risk?

3. How should these patients be treated?

4. What are the characteristic findings?

 

 

Show Answers

Answers

Short answers

1. The diagnosis is tako-tsubo cardiomyopathy, also known as left ventricular apical ballooning and “broken heart syndrome.”

2. It has been traditionally associated with emotional or physical upset in postmenopausal women.

3. Patients should be treated as for acute myocardial infarction. Many develop symptoms of acute left ventricular failure and should be treated as per current guidelines (nitrates, diuretics, etc).

4. Characteristic findings are:

Chest pain or dyspnoea

Electrocardiographic changes suggestive of acute myocardial infarction or elevated cardiac troponin

Triggered by emotional or physical stress

Normal coronary angiogram

Characteristic left ventricular apical “ballooning”

Tako-tsubo cardiomyopathy
Tako-tsubo cardiomyopathy is an increasingly recognised cause of chest pain and dyspnoea in postmenopausal women that often mimics acute myocardial infarction, and should be considered in its differential diagnosis. It was first described in Japan¹ but has subsequently been identified in the USA and Europe.^{2 3 4 5} The condition is sometimes triggered by an episode of emotional stress—hence the occasionally used name “broken heart syndrome.” A recent meta-analysis found an emotional stressor in 27% and a physiological stressor (asthma attack, medical examination or procedure) in 38% of patients.⁶ Initially underestimated, the literature reveals consistent prevalence rates of 1.7-2.7% in patients presenting with presumed acute myocardial infarction.^{6 7} The condition is overwhelmingly seen in women, with rates of 82-100%.^{6 8} The average age at presentation has ranged from 58 to 77 years.⁶

It is the shape of the left ventricle on imaging that gave rise to the name: a “tako-tsubo” is a traditional Japanese clay octopus trap that has the same characteristic shape as the “ballooning” ventricle, caused by reduced contractility of the mid-ventricular and apical segments and hypercontractile basal walls.¹ The most widely accepted diagnostic model is the Mayo criteria (see box).⁴

 

Mayo criteria for the clinical diagnosis of tako-tsubo cardiomyopathy 1. Transient akinesis or dyskinesis of the left ventricular apical and mid-ventricular segments with regional wall motion abnormalities 2. Absence of obstructive coronary disease or angiographic evidence of acute plaque rupture 3. New electrocardiographic abnormalities (either ST segment elevation or T wave inversion) 4. Absence of: Recent significant head trauma Intracranial bleeding Phaeochromocytoma Obstructive epicardial coronary artery disease Myocarditis Hypertrophic cardiomyopathy

Most patients present with chest pain or dyspnoea, with rates approaching 68% and 18%, respectively. Patients can have pulmonary oedema, but reported rates have varied from zero to 46%.^{6 8} The latter series also reported the need for intra-aortic balloon pump insertion in 46% of patients—in excess of the experience in other institutions.^{4 8 9} Nevertheless, haemodynamic instability and cardiogenic shock are certainly possible complications.

The confusion with acute myocardial infarction is not only limited to the symptoms. The electrocardiogram typically shows ST segment elevation, most commonly in the anterior leads (up to 83.9% of patients). T wave changes and even pathological Q waves have been frequently seen.⁶ Cardiac enzyme changes suggest myocardial injury with increases in troponin concentrations in most patients. The troponin seems to peak earlier than in acute myocardial infarction, with highest values seen at presentation. However it is often much lower than one would expect with such extensive regional wall motion abnormalities.¹⁰ Increased concentrations of B-type natriuretic peptide (BNP) have also been seen.¹¹

The pathophysiology of the condition is as yet uncertain, although there are several theories. It is thought to be a catecholamine mediated injury in the context of low circulating oestrogen, perhaps explaining the prevalence in post-menopausal women—though it is far from exclusive to this group. Catecholamine concentrations are in excess of those seen in comparable acute myocardial infarctions¹² and animal models have shown reversibility of the changes with pretreatment with -adrenoreceptor blockade.¹³ The rat model has also shown a protective effect from oestradiol treatment in stress induced cardiomyopathy.¹⁴ Coronary artery vasospasm has been postulated—but the multivessel spasm, which would be required, has been reliably shown in very few patients.⁶ More likely is an abnormality in the microcirculation: measurement of flow rates during early coronary angiography has occasionally shown a reduction.¹⁵ The clinical picture does have similarities to the catecholamine mediated cardiomyopathy found in intracerebral and subarachnoid haemorrhage, also thought to be catecholamine mediated; however in these patients the apex is spared and it is the basal segment of the left ventricle that is hypokinetic.¹⁶ Myocarditis can also produce transient regional wall motion abnormalities but viral titres have been consistently negative in these patients.

A recent UK based series has postulated that the mechanism of injury is mediated not only through a catecholamine response, but also a left ventricular outflow tract obstruction. They found localised mid-ventricular septal thickening causing a mid-ventricular gradient, in effect dividing the ventricle into two. It is proposed that this results in distal subendocardial ischaemia, producing the characteristic changes. Dobutamine stress echocardiography reproduced the gradient, and may play some part in future diagnostic models.¹⁷

It is clearly difficult to differentiate between acute myocardial infarction and tako-tsubo cardiomyopathy and the clear consensus is that patients should initially be treated as the former.¹⁸ Currently, patients fulfilling criteria for ST elevation myocardial infarction should be referred for primary percutaneous intervention (PCI) or thrombolysis according to local guidelines. Early coronary angiography and the advent of primary PCI for acute myocardial infarction allows the identification of tako-tsubo cardiomyopathy and the possible prevention of unnecessary thrombolysis.

Pulmonary oedema due to left ventricular systolic dysfunction is often present and should be treated with supportive measures, nitrates and diuretics. β blockers have shown promise in reversing the “ballooning” of the left ventricle during simulations with dobutamine stress echocardiography and should probably be utilised.¹⁹ Angiotensin converting enzyme (ACE) inhibitors have been anecdotally shown to be effective, although no randomised prospective data yet exist.²⁰

The prognosis is good with return to normal left ventricle function in almost all patients, with recovery of normal performance.^{3 5 6 8} The rate of recurrence in the longest follow-up was low, at 11.4% over 4 years. However almost a third of patients had recurrent chest pain. Mortality was no higher than for an equivalent “normal” population.²¹

Tako-tsubo cardiomyopathy is an important differential of chest pain and indeed acute myocardial infarction, of which all acute physicians should be aware. However consideration of this uncommon diagnosis should not delay prompt reperfusion therapy. While its underlying pathophysiology remains unclear, future research may help develop more accurate diagnostic criteria and specific treatments.

 

Learning points Tako-tsubo cardiomyopathy is a differential diagnosis of chest pain It is most common in postmenopausal women It mimics acute myocardial infarction Treatment for ST elevation or non-ST elevation myocardial infarction should not be delayed while considering this diagnosis It requires coronary angiography to diagnose non-obstructive coronary artery disease The pathophysiology is unclear—but is likely to be catecholamine mediated There is no randomised control trial data for its management, which is currently symptomatic β blockers and ACE inhibitors may be useful

Cite this as: BMJ 2008;337:a107

My Bloggy Personality…

The analysis indicates that the author of http://www.anniec898.wordpress.com is of the type:

INTP – The Thinkers

The logical and analytical type. They are especially attuned to difficult creative and intellectual challenges and always look for something more complex to dig into. They are great at finding subtle connections between things and imagine far-reaching implications.

They enjoy working with complex things using a lot of concepts and imaginative models of reality. Since they are not very good at seeing and understanding the needs of other people, they might come across as arrogant, impatient and insensitive to people that need some time to understand what they are talking about.

Analysis

This shows what parts of the brain that were dominant during writing. Brain activity: Thinking (T): – logic, mathematics; Thinker (NT); Intuition (N) – imagination, symbols…

I was a little surprised by this as I don’t find math or logic my stong points, however, I am adept at many creative things and knew my imagination and symbol usage would be a HUGE component of my personality…on the graph of the brain, the Intuition component was only a small portion of the entire triangle with the Thinking component being the greatest…. Nevertheless, the analysis does fit me rather well…

The Magic of Meme’s:

I am honored to be chosen for this activity. I was selected to write a Meme by Trauma Junkie at the blog Surviving RT School — Tales of a Trauma Junkie ( at http://my-rt-life.blogspot.com). I didn’t really know WHAT a meme was so I looked it up….

“A meme (pronounced /miːm/)^[1] is any idea or behavior that can pass from one person to another by learning or imitation. Examples include thoughts, ideas, theories, gestures, practices, fashions, habits, songs, and dances. Memes propagate themselves and can move through the cultural sociosphere in a manner similar to the contagious behavior of a virus.

Richard Dawkins coined the word “meme” as a neologism in his book The Selfish Gene (1976) to describe how one might extend evolutionary principles to explain the spread of ideas and cultural phenomena. He gave as examples melodies, catch-phrases, beliefs (notably religious belief, clothing/fashion, and the technology of building arches).^[2]

Meme-theorists contend that memes evolve by natural selection (similar to Darwinian biological evolution) through the processes of variation, mutation, competition, and inheritance influencing an individual entity’s reproductive success. Thus one can expect that some memes will propagate less successfully and become extinct, while others will survive, spread, and (for better or for worse) mutate. “Memeticists argue that the memes most beneficial to their hosts will not necessarily survive; rather, those memes that replicate the most effectively spread best, which allows for the possibility that successful memes may prove detrimental to their hosts.”^[3]“

Another way to define a Meme: “Memes are contagious ideas, all competing for a share of our mind in a kind of Darwinian selection. As memes evolve, they become better and better at distracting and diverting us from whatever we’d really like to be doing with our lives. They are a kind of Drug of the Mind. Confused? Blame it on memes.” Richard Brodie.

After looking up exactly what a Meme was…I am inspired. So, here are the rules:

Pass it on to five other bloggers, and tell them to open the nearest book to page 56. Write out the fifth sentence on that page, and also the next two to five sentences. The CLOSEST BOOK, NOT YOUR FAVORITE, OR MOST INTELLECTUAL!

I am currently in my office (aka computer room, study arena) which is currently a DISASTER because I am remodeling and I have books EVERYWHERE. Since I read a vast array of genres, the closet book at hand was: Spells: Spellcraft to bring magic to your life and reality to your desires.

Turning to page 56 I find: A Spell to Halt Nightmares –

Children are much more sensitive to psychic influences than the average adult, and nightmares, when suffered for a long period of time, may be a symptom of psychic attack. Regardless of the causes behind a child’s suffering continual nightmares there is a magical solution that may prove effective. You will need: a sheet of purple  paper, a black marker , salt, water, and perfume,  and a raw potato. Copy the following magical name on a sheet of paper, making a triangular shape ABRACADABRA. Place the design above the child’s bed being sure to explain what its intention is. Spray or sprinkle the room with the mixture of salt, water, and perfume. Each time you sprinkle the room recite the following: “Guidance and love of the universe, please protect my child  from the night terrors that assault him. In your loving arms I commit my child to your protection when he is asleep. I do this in the name of love and faith.”

Well, I thought that was interesting. After my graveyard shift, I had a nightmare about a Telemetry interpretation gone wrong…hmmm…

I am not sure how to perpetuate this game since I am really new to blogging and not super sure how to link or express invites…so I am encouraging the next five people who  visit my blog to please add a comment which includes their blog link, make a Meme so the evolution occurs….Blessings and Light!

Stem Cell Therapy…

I had the opportunity to be a “real” college student for a change and attend a lecture I was most interested in…the title: “The Promise of Embyronic Stem Cell Therapy: Euphoria or Ethical Quagmire.” By Nobel Prize Winner Dr. Mario Capecchi.

He did a great job of taking his area of expertise with all of the complexities, and in depth scientific parameters,  and “dumbing it down” for those of us not enlightened with the knowledge he possesses. I really was able to relate a lot of his research parameters and methodologies to what I am learning in Cell Biology.  Therefore, I thought it was a fabulous lecture.

Here are some of the highlights:

• There are primarily two main categories of stem cells used in research today…those with symmetric cell division (liver and blood vessels) and those with asymmetric cell division ( intestine, skin, blood). Within the two categories, two types of stem cells are considered: Embryonic and Adult. Embryonic stem cells grow rapidly, are versatile, and pluripotent; whereas, adult stem cells have slow growth processes, are restricted, and less controversial of the two stem cell variants.

• Adult stem cells are hard to use therapeutically because they are hard to isolate, difficult to purify, and have restricted differentiation potential. Also, they are programmed for apoptosis. However, the lessons that are important that are derived from adult stem cell research and utilization are: the discovery that many tissues have dedicated stem cells, stem cell division is slow, giving rise to fast rising off-spring.

• Embryonic stem cells, from the progenitor cell, can separate into many types of cells, whereas, the adult stem cells are already programmed to dedicate themselves to one specific type of function or growth pattern.

• Zones of differentiation = zones that make the cell different, that give the cell or a group of cells a specific functional responsibility. Zones of proliferation = zones that keep the cell dividing; living; progressing.

ETHICAL CONTROVERSY –

• The biggest controversy today is whether to use human embryos (those that are normally thrown out by fertility clinics) for study or to discard them. Over 20,000 early human embryos are discarded each year by fertility clinics.
• During the Bush administration, laws that restrict scientific study were implemented. Those laws allowed for older stem cells that were extracted prior to 1985 to be used. These are contaminated and not viable for medical treatment.
• Currently the isolation of human embryonic stem cells can occur in private companies but not in institutions that receive public funding (such as Universities). This is the worst possible scenario because no regulation occurs, no publication requirements defining research methodology and outcomes occurs, and no transparency occurs (there is no reference points for comparison, no open discussion about results and their application, and this is dangerous).

Dr. Cappechi said: “Knowledge is never evil in itself. Application of knowledge can be either good or bad, but for the application to result in good, it requires input from many fields, belief systems, political ideals, and general ideologies.”

Afterwards, I attended a “meet and greet” and I asked the following question: Do you use cell signaling within the cell cycle to determine the difference between the zones of differentiation and proliferation? The component of the response that I recall was: “There is some significance during mitotic and meiotic division for signaling to occur for these zones to enhance the job of the cell, but there is still so much we are not sure about in terms of the signaling process. We know signaling ties the zones together, but we are still determining the sequencing pathways that tie the process together while keeping them working as individual entities.” The answer had much more depth, but

It was an interesting lecture and discussion and has given me much to contemplate. I am an advocate of stem cell research and hope that some of the restrictions can be lifted so therapeutic advances can occur, although they may be long in the coming. I’d love to hear opinions about stem cell research…

Heart-Lung Pump In A Bypass Environment…

I am studying like mad for a Patho test on Thursday and have lots on my mind to blog about, but no time…thus, the filler. Hopefully you will find this as interesting as I did. I LOVE anything to do with heart/lung issues… Blessings and Light.

Management of Electricity…

An electric feel…the Human Body DOES make electricity via the conduction system of the heart. When that conduction is a little off, interesting things happen. One of the new Paroxysmal Supraventricular Tachycardia’s that I am studying is called “Circus Movement Tachycardia.” This is a component of Wolfe-Parkinson-White syndrome and is usually a short beat of a rhythm that is defined as WPW. It is initiated by a Premature Atrial Contraction followed by QRS that alternates in height and depth. Heart rate is generally 150 to 250 bpm. P waves typically follow the QRS complex and is separate from it. The QRS complex is narrow. The rhythm is called “circus movement” because of how the ventricular impulse re-enters the atria…The electrical impuse of re-entry passes down the AV node to the ventricles and the circuit established from the AV node and its accessory pathway is out of synchronization with each other, thus, QRS alternans. Also, a patient who is symptomatic with CMT is in danger of developing A-fib….with the ventricular responce converting to a heart rate between 200-300 bpm….a dangerous arrhythmia!

Prevention through appropriate diet and exercise is always the best way to make positive electricity — particularly where the heart is concerned. However, if one’s electrical conduction is off…there are mechanisms to treat the problem: 1) transvenous readiofrequency ablation of the accessory pathway…this cures the patient of the CMT and eliminates the threat of sudden death due to A-fib. 2) Cardioversion is a temporary fix, and effective long term if the patient is paced.

Necessary and Sufficient…

These Cell Biology concepts are so easy they are complex! Still trying to consolidate in my mind all of the complexities, because if I think about the nuances for too long, I feel like I am in a circular philosophical argument…Necessary = a condintion whereby A is said to be necessary for a condition B, if (and only if) the non-occurrence of A guarantees the non-occurrence of B. Sufficient = a condition whereby A is said to be sufficient for a conditon B if the occurrence of A guarantees the occurrence of B. SO, I explained it by illustrating the role of the centrosome –> it has a key role in efficient mitosis but is not necessary for mitosis to occur. “Centrosomes are not required for the progression of mitosis. WHen the centrosomes are irradiated by a laser, mitosis proceeds normally with a morphologically normal spindle….many cells can undergo interphase without centrosomes (thus, deeming them not necessary) .” Interesting…still trying to explain Sufficient. If anyone has a good example pertaing to the cell of Sufficient, or an easier way to make these concepts a little more clear and concise, I would appreciate your input!

Body Worlds & The Story of the Heart…

I was fortunate enough to be able to enjoy this exhibit, which, for me, was an experience of a lifetime. I have a heart condition so, the break-down of the heart, and all of the anatomy associated with circulation was intriguing. I also loved the pulmonary, and urinary anatomy. The exhibit will be in the U.S. until January or February. For more information check out: www.bodyworlds.com. It is a worthwhile visit if one can get to it, and I HIGHLY recommend it!

I thought it was most interesting to see how the cadavers were preserved…and I was able to identify components of Human Anatomy much more readily on these cadavers than those placed in the formaldehide-like solution we have in lab at school. I was impressed from the inception of the exhibit. One of the first quotes that struck me was: “in religion, art, and literature…the healthy heart is a symbol of love, happiness, compassion and courage…The first functioning organ to develop after conception, the heart, nourishes, regulates, and sustains the body throughout our lives….more than a pump, more than a ticker it is viewed as a container of our deepest emotions and highest values, the wellspring of our courage and resolve…” Dr. Gunther von Hages and Dr. Angelina Whallery.

Another component of the exhibit discussed “Broken Heart Syndrome.” There is a great article about this diagnosis at: http://www.pubmedcentral.nih.gov.  I had a patient about 3 months ago who was admitted to the ICU with this exact diagnosis. I thought at the time it was very rare. My patient was devastated over the unexpected death of a son, and she was not coping with it well. The physiological manifestations were similar to that of an MI (i.e. SOB, chest pain, fluid in the lungs, and a severely weakened heart muscle); and, her rhythm strip showed ST-segment elevation and deep T-wave inversions in the anterior leads, as well as, a prolonged QT interval. At Body Worlds & The Story of the Heart I learned that this diagnosis is a toxic overload of stress hormones that result in a stress cardiomyopathy. “A resilient person may recover within a few days without any permanent damage to the heart. Those who cannot recover from grief can stress their hearts to death [paraphrased].” Apparently, it is a much more common occurrence diagnostically than originally believed.

I think one of the things that I loved most about this exhibit is that it does an amazing job of tying together the worlds of science and art…it is very DaVinci-esque…one quote that I jotted down that I feel supports my assessment is this: “Faith is an oasis in the heart which will never be reached by the caravan of thinking.” Kahlil Gibran.