by Justin
Price, MD, Jinesh Shah, MD, Michael Q. Bui, MD, and Christopher D. Chiles, MD,
FACC
A previously
healthy 36-year-old woman presented at the emergency department with
gradual-onset confusion, ataxia, and aphasia. Her vital signs were normal. On
physical examination, she reacted to painful stimuli but was nonverbal and
unable to follow commands. Initial laboratory results revealed no abnormalities.
Computed tomograms of the head and results of a lumbar puncture were
nondiagnostic. During hospitalization, the patient decompensated and needed emergency
intubation and vasopressor support. An electrocardiogram (ECG) was obtained
(Fig. 1). An echocardiogram revealed an acute reduction of left ventricular ejection
fraction (range, 0.35–0.40) and anterior wall-motion abnormalities. Notable laboratory
results included troponin I, 17.1 ng/mL; normal thyroid values; and negative toxicology
screening.
