Present an interesting case from your clinical practice in 4 minutes that demonstrates registrar-level decision-making.

Question

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I'd present a 64-year-old woman admitted with chest pain post-bereavement. Initial ECG showed anterolateral T-wave inversion and troponin was elevated. Coronaries were clean on angiography but the LV gram showed apical ballooning consistent with Takotsubo cardiomyopathy. My decision point was anticoagulation given apical akinesia and stroke risk versus bleeding from her recent fall. I weighed the limited evidence — small observational series suggesting benefit when EF <35% with apical thrombus risk — discussed with cardiology and chose three months of anticoagulation with serial echo. She recovered LV function at six weeks. The learning for me was that absence of CAD doesn't mean absence of risk, and that early echo guides management more than ECG alone. I shared this case at our departmental meeting and added apical thrombus screening to our local Takotsubo pathway.

Interesting case presentation: cardiology

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