Journal of Postgraduate Medicine
 Open access journal indexed with Index Medicus & ISI's SCI  
Users online: 1506  
Home | Subscribe | Feedback | Login 
About Latest Articles Back-Issues Articlesmenu-bullet Search Instructions Online Submission Subscribe Etcetera Contact
 ::  Similar in PUBMED
 ::  Search Pubmed for
 ::  Search in Google Scholar for
 ::  Article in PDF (1,038 KB)
 ::  Citation Manager
 ::  Access Statistics
 ::  Reader Comments
 ::  Email Alert *
 ::  Add to My List *
* Registration required (free) 

  IN THIS Article
 ::  References

 Article Access Statistics
    PDF Downloaded12    
    Comments [Add]    

Recommend this journal


  Table of Contents     
Year : 2013  |  Volume : 59  |  Issue : 4  |  Page : 337-338

Author's reply

Department of Medicine, Shri Aurobindo Institute of Medical Sciences, Indore, Madhya Pradesh, India

Date of Web Publication17-Dec-2013

Correspondence Address:
P Joshi
Department of Medicine, Shri Aurobindo Institute of Medical Sciences, Indore, Madhya Pradesh
Login to access the Email id

Source of Support: None, Conflict of Interest: None

Rights and PermissionsRights and Permissions

How to cite this article:
Joshi P. Author's reply. J Postgrad Med 2013;59:337-8

How to cite this URL:
Joshi P. Author's reply. J Postgrad Med [serial online] 2013 [cited 2023 Sep 29];59:337-8. Available from:


Thank you for your comments. [1] We did think of Takotsubo cardiomyopathy (TCC) in the differential diagnosis.

TCC or apical ballooning syndrome is a clinical entity mimicking acute coronary syndrome. It occurs mostly in women, postmenopausal, elderly and this accounts for 90% of cases in most case series. [2] The most common symptom is chest pain at rest though some patients can have dyspnea. The Electrocardiogram (ECG) findings is of mild ST segment elevation in 50-60% patients, but nonspecific ST-T changes can also be present and these changes resolve with deep T wave inversion. [3] Troponin levels are only mildly elevated and two-dimensional (2D) echocardiography shows wall motion abnormality which extends beyond the distribution of any one single coronary artery. Patients with this disorder present in the emergency department with all these features and do not subsequently develop it over the course of time.

Our patient was a middle age male who presented with symptoms and signs of organophosphorus poisoning. At presentation there was no chest pain or dyspnea and the ECG was normal. 2D echocardiography was suggestive of involvement of a single coronary artery. Troponin values were significantly raised and subsequent ECG did not show deep T inversion. With these in mind, it is unlikely that this patient might be suffering from TCC. Coronary angiography is diagnostic of this condition which shows absence of obstructive coronary artery disease. This was not done in our case due to financial constraints.

 :: References Top

1.Senthilkumaran S, Balamurugan N, Jayaraman S, Thirumalaikolundusubramaniam P. Cardiotoxicity in OPC poisoning: Time to think differential diagnosis. J Postgrad Med 2013;59:337.  Back to cited text no. 1
  Medknow Journal  
2.Koulouris S, Pastromas S, Sakellariou D, Kratimenos T, Piperopoulos P, Manolis AS. Takotsubo cardiomyopathy: The "broken heart" syndrome. Hellenic J Cardiol 2010;51:451-7.  Back to cited text no. 2
3.Prasad A. Apical ballooning syndrome: An important differential diagnosis of acute myocardial infarction. Circulation 2007;115:e56-9.  Back to cited text no. 3


Print this article  Email this article
Online since 12th February '04
2004 - Journal of Postgraduate Medicine
Official Publication of the Staff Society of the Seth GS Medical College and KEM Hospital, Mumbai, India
Published by Wolters Kluwer - Medknow