ABSTRACT
Platypnea-orthodeoxia syndrome is a rare cause of positional hypoxemia and dyspnea. We present the case of a 54-year-old man with right-to-left shunting through a patent foramen ovale in the setting of metastatic cholangiocarcinoma resulting in platypnea-orthodeoxia syndrome. The shunt was originally not visualized on cardiac magnetic resonance imaging but later detected with transesophageal echocardiography. This case highlights the importance of complimentary multimodality cardiac imaging in the diagnosis of both common and uncommon disorders.
Subject(s)
Bile Duct Neoplasms , Cholangiocarcinoma , Foramen Ovale, Patent , Male , Humans , Middle Aged , Platypnea Orthodeoxia Syndrome , Posture , Foramen Ovale, Patent/diagnosis , Foramen Ovale, Patent/diagnostic imaging , Echocardiography, Transesophageal/adverse effects , Dyspnea/etiology , Dyspnea/complications , Hypoxia/diagnosis , Hypoxia/etiology , Cholangiocarcinoma/complications , Cholangiocarcinoma/diagnosis , Bile Duct Neoplasms/complications , Bile Duct Neoplasms/diagnosis , Bile Ducts, IntrahepaticABSTRACT
A 68-year-old female with past medical history of hypertension, hyperlipidemia, multiple sclerosis, diverticulitis, and tobacco use presented with 1 day of atypical chest pain after a recent diverticulitis flare. Initial workup was notable for a normal electrocardiogram but elevated high sensitivity troponin T (616 ng/L). Due to persistent symptoms, the patient was given antiplatelet therapy and taken urgently to the catheterization lab where she was found to have complete occlusion of an anomalous right coronary artery branching off the mid-left anterior descending artery. Angioplasty was performed with a drug-eluting stent and her symptoms resolved. The patient recovered well and was discharged on appropriate medical therapy. This case demonstrates a case of acute coronary syndrome in an extremely rare coronary congenital abnormality. Further research is needed on when to be suspicious for coronary anomalies on patients presenting with myocardial infarction.
Subject(s)
Acute Coronary Syndrome , Diverticulitis , Drug-Eluting Stents , Humans , Female , Aged , Acute Coronary Syndrome/diagnostic imaging , Acute Coronary Syndrome/etiology , Acute Coronary Syndrome/therapy , Coronary Vessels , Treatment OutcomeABSTRACT
BACKGROUND: Coronavirus disease 2019 (COVID-19) is a syndrome that has been associated with multiple cardiac complications including myopericarditis. The pathophysiology and treatment for myopericarditis in the setting of COVID-19 infection is still under investigation. CASE SUMMARY: We present a case of a 60-year-old male admitted for dyspnoea due to COVID-19. He developed new ST-segment elevation, elevated cardiac enzymes, severe left ventricular dysfunction, and high inflammatory markers in the setting of haemodynamic and respiratory collapse from the viral illness. He was diagnosed with COVID-19-induced myopericarditis. He showed rapid clinical improvement with a rapid wean off pressure support, resolution of electrocardiogram (ECG) findings, and recovery of left ventricular systolic function following treatment with intravenous immunoglobulin (IVIG) and methylprednisolone. DISCUSSION: COVID-19's complex and devastating complications continue to create new challenges for clinicians. Cardiac complications, specifically, have been shown to be a signal for worse prognosis in these patients. IVIG and steroids can inhibit the inflammatory cascade and decrease myocardial injury, with implications in treatment of severe myopericarditis.