Validation of the MIRACLE Score for Prognostication After Out-of-hospital Cardiac Arrest.

Background: Out-of-hospital cardiac arrest (OHCA) is associated with very poor clinical outcomes. An optimal pathway of care is yet to be defined, but prognostication is likely to assist in the challenging decision-making required for treatment of this high-risk patient cohort. The MIRACLE score provides a simple method of neuro-prognostication but as yet it has not been externally validated.

What becomes of the broken-hearted? A typical case of Takotsubo cardiomyopathy.

Takotsubo cardiomyopathy (TC), or apical ballooning syndrome (ABS), is becoming an increasingly recognised entity. Usually preceded by emotional stress, it is characterised by chest pain associated with ST-segment elevation on the 12-lead electrocardiogram (ECG), elevated cardiac biomarkers, and reversible left ventricular (LV) apical hypokinesia, making it an important differential diagnosis for ST-segment elevation myocardial infarction (STEMI). We present a typical case of TC initially misdiagnosed and treated as a STEMI, fortunately with no adverse consequences.