Left Sided Mc Connells Sign: A Classic Finding in a Rare Condition

Abstract

This case report describes a 32-year-old woman with systemic lupus erythematosus complicated by crescentic lupus nephritis and end-stage renal failure on haemodialysis, who presented to the emergency department with breathlessness, chest pain and haemoptysis. Troponin was elevated, and echocardiography showed severe hypokinesis of the septum, anterior wall and basal inferior wall with preserved or even hyperkinetic apical function; speckle tracking echocardiography showed preserved apical strain with markedly reduced strain in the basal segments. A presumptive diagnosis of basal variant takotsubo cardiomyopathy was made. The patient was treated with emergent haemodialysis and carvedilol and improved rapidly; she declined coronary angiography. Repeat echocardiography 48 hours after presentation showed normalisation of left ventricular systolic function, and the patient later reported having become distraught during an argument immediately before her symptoms began. The authors note that the basal type is a rare variant of takotsubo cardiomyopathy and that echocardiography plays a pivotal role in diagnosis when coronary angiography cannot be performed. Drawing on McConnell's sign, a specific echocardiographic finding in acute pulmonary embolism, and the proposed “reverse McConnell's sign” of right ventricular involvement in takotsubo cardiomyopathy, they suggest that left ventricular apical hyperkinesis with basal and midventricular hypokinesis could be considered a “left sided McConnell's sign” that should suggest basal or midventricular variants of the condition.

Abstract prepared by the editorial office from the full text of the article; the authors did not supply one.