Acute cardiac event with slurring J-wave or “Lamda-like” J-wave on ECG and Left ventricle systolic dysfunction

Dr. Andrés R. Pérez Riera
Brazil

Case presentation

64-year-old, female patient, Caucasian, housewife. She described having been admitted in another hospital after being operated to treat her for rectal cancer. Suddenly she presented symptoms of dyspnea and after performing an ECG (ECG-1) she was transferred to the Messejana hospital. She was admitted with increased heart rate, regular cardiac rhythm, threefold split. No murmur.
Lung auscultation: Bibasilar lung crepitant rales. ECG-1

Chest X-rays, PA, compatible with bilateral pulmonary congestion and cardiomegaly +++
Troponin T: 0.764 ng/mL (reference value 0,030 ng/mL); Creatine Kinase-MB CK-MB mass: 3.78 mkat/L (Calcium: 99mgdL,)

After performing ECG-2, the patient was referred to the hemodynamic lab where she underwent ventricular angiography. The ventriculogram revealed severe mitral valve insufficiency (absent at admission) + severe contractile dysfunction.

Questions

1. What is the diagnosis of ECG-1?

What is the diagnosis of ECG-2 ?
What is the most likely clinical diagnosis? Base your hypothesis.

Apresentação do caso

64 anos, sexo feminino, branca, dona-de-casa. Refere que estava internada em outro hospital após ser operada para tratamento de câncer de reto. Subitamente apresentou quadro de dispneia e após a realização do ECG ( ECG-1) foi transferida para o hospital de Messejana. Deu entrada com FC elevada. RCR 3 tempos. Sem1 sopro. Estertores crepitantes pulmonares bi basais.
Rx tórax PA compatível com congestão pulmonar bilateral e cardiomegalia +++

Troponina: 0,764 (valor de referencia é de até 0,030 ng/ml), CK MB massa: 3,78 (Calcio: 99mgdL)
Após a realização do ECG-2 foi encaminhada para hemodinâmica onde se realizou cine-ventrículo-coronariografia. O ventriculograma revelou insuficiência mitral severa (ausente na admissão) + disfunção contrátil.