Stress-Induced Cardio Myopathy on Mar 26, 2022 (without experiencing any stress-related event) See Continuation Page below #18 CARDIAC CATH - Interpretation Summary   No angiographic evidence of coronary artery disease High left ventricular end-diastolic pressures. Cardiogenic shock., Consider stress induced cardiomyopathy    CONCLUSIONS: 1. No angiographic evidence of coronary artery disease 2. High left ventricular end-diastolic pressures. 3. Cardiogenic shock., Consider stress induced cardiomyopathy   RECOMMENDATION: 1. Transfer to ICU 2. Will start levophed and milrinone. Furosemide 80mg given in the cath lab post procedure 3. Obtain echcoardiogram 4. Continue medical therapy   Procedures Performed:               Left Heart Catheterization (Radial approach)               Selective Coronary Angiogram               Moderate Sedation   Procedure Details: Informed consent was obtained prior to the procedure. Patient was brought to the lab and prepped and draped in a sterile fashion. A time-out procedure was performed. Vascular access was obtained in the R radial artery after confirming dual-blood supply to the right hand using a modified Allen's test. A 5 Fr outer (6F inner) sheath was placed using modified Seldinger technique. Patient received 3000U of IV heparin, 5 mg Verapamil and 400 mcg of IA nitroglycerin. Other doses of IA and IC medications as per nursing notes.   LHC: Left heart catheterization was performed in the standard fashion using a 5F Tiger to gain access into the LV. The LVEDP was noted to be 20 mm of Hg. The catheter was pulled back into the aorta revealing a gradient of 0 mmHg   Coronary Angiogram: After access was obtained into the arterial system as documented above, coronary angiogram was performed in the standard fashion using a 5F Tiger and JL3.5 catheter preformed catheters. The following findings were noted per diagram below:   At the end of diagnostic coronary angiogram, all catheters were removed in an atraumatic fashion over a wire. Radial hemostasis band was used for non-occlusive hemostasis confirmed with a reverse Barbeau test. At the end of the procedure, patient returned to the recovery area in a stable condition. Patient and/or family were appraised of the findings #18 Continued CV TRANSTHORACIC ECHO 2D  Interpretation Summary  LEFT VENTRICLE: normal size. Normal wall thickness. Sigmoid septum. The following segments are severely hypokinetic: mid and distal anteroseptum, apex, mid and distal inferior, mid and distal anterior, distal inferolateral; the basal segments are hyperdynamic. Moderately reduced systolic function with an EF=40%. Abnormal relaxation with normal filling pressures.  RIGHT VENTRICLE: normal size and function.  LEFT ATRIUM: normal size. Lipomatous septum. No obvious IAS on color Doppler.  RIGHT ATRIUM: normal size. Estimated CVP is 5 mmHg.  AORTIC VALVE: trileaflet. Focal calcification of NCC. No aortic stenosis. No significant AI. MITRAL VALVE: thickened leaflets. Mild MAC. No MS. Trace MR. TRICUSPID VALVE: normal. Mild TR. Estimated RVSP is 32 mmHg, assuming CVP of 5 mmHg.   PULMONIC VALVE: normal by Doppler exam. Trace PI. PERICARDIUM: no effusion.  AORTA: normal aortic root size. The visualized portions of the ascending aorta were normal in size.     CONCLUSIONS-   Technically difficult study, echo contrast used.  Moderately reduced LV systolic function, LVEF=40%. Normal LV filling pressures.  Wall motion abnormalities consistent with stress induced cardiomyopathy (in the setting of no significant CAD).  LVOT flow acceleration without significant gradient. There is systolic anterior motion of the anterior mitral leaflet.