CHEST 2023 On Demand Pass-Broken Hearts

Video Transcription

Video Summary

This video transcript includes several cases discussed during a medical session on pulmonary critical care. The first case presented is about a 21-year-old woman who had multiple syncopal episodes and other symptoms such as dizziness and weakness. An electrocardiogram (EKG) showed a polymorphic VTAC, and she was brought to the ICU and treated with esmolol and amiodarone, which resulted in sinus rhythm. Further investigations, including a cardiac MRI, procainamide challenge, and exercise stress testing, identified the location of the arrhythmias in the right ventricular outflow tract. The patient underwent ablation, which successfully resolved the VTAC and PVCs. This case highlights the importance of investigating PVCs to determine if they are benign or malignant and the need for further workup to identify any underlying structural abnormalities or channelopathies. The second case involves a 26-year-old healthy male who experienced sudden cardiac arrest while working out in the gym. He was found to have myocardial bridging, a rare congenital variant, which occurs when a portion of the major coronary arteries descends into the myocardium. This can potentially lead to complications such as heart failure, arrhythmias, and thromboembolism. In this case, the patient's coronary artery bridging caused a thromboembolic stroke, and he was started on anticoagulation therapy. The third case is about a 46-year-old female who presented with a stroke and was found to have left ventricular non-compaction (LVNC) , a congenital cardiomyopathy. LVNC can increase the risk of heart failure, arrhythmias, and thromboembolism. In this case, the patient had a thromboembolic stroke due to blood stasis in the non-compacted myocardial tissue. She was started on anticoagulation therapy with a DOAC (direct oral anticoagulant) . The fourth case is about a 59-year-old male who presented with hemoptysis and was initially diagnosed with pulmonary embolism (PE) based on a CT angiogram. However, further evaluation revealed a coronary artery fistula, a rare congenital anomaly. The patient underwent percutaneous transcatheter embolization to occlude the fistula and resolve the symptoms. This case highlights the need for further characterization of coronary artery fistulas and individualized management based on the specific anatomy and pathophysiology involved. The final case involves a 27-year-old male with small-volume hemoptysis and hypoxemia who was initially diagnosed with acute pulmonary embolism (PE) based on a CT angiogram. However, further examination revealed that the patient had congenital heart disease, specifically a Glenn anastomosis, which caused the mixing artifact on the imaging and mimicked a PE. The patient also had pulmonary arteriovenous malformations (AVMs) that caused the hemoptysis. The AVMs were successfully embolized, leading to resolution of the symptoms. This case emphasizes the importance of considering alternative diagnoses in patients with atypical presentations and congenital heart disease.

Meta Tag

Category Cardiovascular Disease

Session ID 4019

Speaker tanjeev ahmad

Speaker Maanvita Gorrepati

Speaker Tasmea Haque

Speaker Jacob McAuliffe

Speaker Mihir Odak

Speaker Mason Paas

Track Cardiovascular Disease

Keywords

pulmonary critical care

syncopal episodes

myocardial bridging

LVNC

coronary artery fistula

acute pulmonary embolism

congenital heart disease