Clinical Cases in the Management of Complex Cardiovascular Disease

139 Pages·2023·5.585 MB·English

by  Atooshe Rohani

Clinical Cases in Cardiology
Series Editors: Ravi V. Shah · Siddique A. Abbasi · James L. Januzzi
Atooshe Rohani
Clinical Cases in
the Management
of Complex
Cardiovascular
Disease
Clinical Cases in Cardiology
Series Editors
Ravi V. Shah, Boston, MA, USA
Siddique A. Abbasi, Providence, RI, USA
James L. Januzzi, Boston, MA, USA
Clinical cases are a key component in modern medical ed-
ucation, assisting the trainee or recertifying clinician to
work through unusual cases using best practice techniques.
Cardiology is a key discipline in this regard and is a highly
visual subject requiring the reader to describe often very sub-
tle differences in the presentation of patients and define ac-
curately the diagnostic and management criteria on which to
base their clinical decision-making.
This series of concise practical guides is designed to facili-
tate the clinical decision-making process by reviewing a num-
ber of cases and defining the various diagnostic and manage-
ment decisions open to clinicians.
Each title will be illustrated and diverse in scope, ena-
bling the reader to obtain relevant clinical information re-
garding both standard and unusual cases in a rapid, easy to
digest format.
Atooshe Rohani
Clinical Cases in the
Management of
Complex Cardiovascular
Disease
Atooshe Rohani
Northern Ontario School of Medicine
Thunder Bay, ON, Canada
ISSN 2523-3009 ISSN 2523-3017 (electronic)
Clinical Cases in Cardiology
ISBN 978-3-031-24527-5 ISBN 978-3-031-24528-2 (eBook)
https://doi.org/10.1007/978-3-031-24528-2
© The Editor(s) (if applicable) and The Author(s), under exclusive license to
Springer Nature Switzerland AG 2023
This work is subject to copyright. All rights are solely and exclusively licensed by
the Publisher, whether the whole or part of the material is concerned, specifically
the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting,
reproduction on microfilms or in any other physical way, and transmission or
information storage and retrieval, electronic adaptation, computer software, or
by similar or dissimilar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service
marks, etc. in this publication does not imply, even in the absence of a specific
statement, that such names are exempt from the relevant protective laws and
regulations and therefore free for general use.
The publisher, the authors, and the editors are safe to assume that the advice and
information in this book are believed to be true and accurate at the date of pub-
lication. Neither the publisher nor the authors or the editors give a warranty,
expressed or implied, with respect to the material contained herein or for any
errors or omissions that may have been made. The publisher remains neutral
with regard to jurisdictional claims in published maps and institutional
affiliations.
This Springer imprint is published by the registered company Springer
Nature Switzerland AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
Contents
1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
2 Digoxin Toxicity in a Patient with Pacemaker . . . . . . 3
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
3 Myocarditis and Cardiogenic Shock . . . . . . . . . . . . . . . 7
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
4 Tachycardia Mediated Cardiomyopathy
and Cardiogenic Shock . . . . . . . . . . . . . . . . . . . . . . . . . 11
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
5 Cardiac Arrest in Cardiac Rehabilitation Then
an Alarming ICD While on Vacation . . . . . . . . . . . . . . 15
Further Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
6 Atrioventricular Block in the Context
of Inferior ST Elevation Myocardial Infarction
(STEMI) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Further Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
7 Carcinoid Tumor and Peripheral Edema . . . . . . . . . . . 25
Further Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
8 Saddle Pulmonary Embolism and Atrial
Fibrillation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
9 Non-ST Elevation MI and Spontaneous
Coronary Artery Dissection . . . . . . . . . . . . . . . . . . . . . 35
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
vi Contents
10 RV Lead Integrity Warning Following by
Inappropriate ICD Shock . . . . . . . . . . . . . . . . . . . . . . . 41
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
11 Post Dialysis Hypotension, New Diagnosis
of HOCM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Further Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
12 Mitral and Aortic Valve Disease in a Patient
with End Stage Renal Disease . . . . . . . . . . . . . . . . . . . 49
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
13 Sustained Monomorphic Ventricular
Tachycardia (SMVT) in a Patient with ICD.
No Shock Delivered. What Is Going Wrong? . . . . . . . 53
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
14 MV Endocarditis and Stroke . . . . . . . . . . . . . . . . . . . . 59
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64
15 Recurrent Chest Pain and Lytic Lesion
in the Spine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
16 Acute Type A Aortic Dissection in a
Young Man . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74
17 Long QT and Atrial Fibrillation: Are These
a Related Entity or Not? . . . . . . . . . . . . . . . . . . . . . . . . 77
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
18 SCN5A Mutation and Syncope . . . . . . . . . . . . . . . . . . . 83
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
19 Tachycardia Mediated Cardiomyopathy
Recovered After Successful Atrial Flutter
and Fibrillation Ablation . . . . . . . . . . . . . . . . . . . . . . . . 89
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92
20 Recurrent Myocarditis . . . . . . . . . . . . . . . . . . . . . . . . . . 95
Further Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
Contents vii
21 ST Depression in Holter, Associated
with Chest Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .101
22 Asymptomatic Mobile Cardiac Mass . . . . . . . . . . . . . .103
Further Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .105
23 Shortness of Breath on Exertion and Mobitz
Type 1 AV Block . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .107
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .109
24 Asymptomatic Atrial Flutter with Rapid
Ventricular Response Left Atrial
Appendage (LAA) Clot and Heart Failure
with Reduced EF . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .111
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .113
25 Bradycardia and Hypotension in a Covid-19
Positive Patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .115
25.1 Physical Examination . . . . . . . . . . . . . . . . . . . . . .116
25.2 Investigations . . . . . . . . . . . . . . . . . . . . . . . . . . . . .117
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .118
26 Myotonic Dystrophy Type 2 and
Cardiomyopathy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .121
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .124
27 Concomitant Hypertrophic Cardiomyopathy
and Aortic Valve Stenosis in a Patient
with Shortness of Breath . . . . . . . . . . . . . . . . . . . . . . . .125
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .129
28 Takotsubo Cardiomyopathy . . . . . . . . . . . . . . . . . . . . .131
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .135
29 Frequent ICD Shock Despite Being on
Amiodarone, a Double Edge Sword! . . . . . . . . . . . . . .137
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .140
30 RA MASS, Tumor or Clot in a Breast
Cancer Patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .141
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .143
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .145
Abbreviations
AF Atrial fibrillation
ARNI Angiotensin receptor neprilysin inhibitor
ATP Antitachycardia pacing
AVR Aortic valve replacement
BNP Brain natriuretic peptide
BrS Brugada syndrome
CAD Coronary artery disease
CCU Critical care unit
CHF Congestive heart failure
CMR Cardiac magnetic resonance
COPD Chronic obstructive pulmonary disease
CPAP Continuous positive airway pressure
therapy
CrCl Creatinine clearance
CT Computed tomography
CTA Computed tomography angiogram
CTO Chronic total occlusion
DCM Dilated cardiomyopathy
DVT Deep vein thrombosis
ECG Electrocardiography
EF Ejection fraction
GFR Glomerular filtration rate
HFrEF Heart failure with reduced ejection
fraction
HOCM Hypertrophic obstructive
cardiomyopathy
ICD Implantable cardioverter-defibrillator
INR International normalized ratio
LAA Left atrial appendage
x Abbreviations
LAD Left anterior descending artery
LCX Left circumflex
LGE Late gadolinium enhancement
LMWH Low-molecular-weight heparin
LQTS Long QT syndrome
LV Left ventricle
LVEDP Left ventricular end-diastolic pressure
LVEF Left ventricle ejection fraction
LVOT Left ventricular (LV) outflow tract
LVOTO Left ventricular outflow tract
obstruction
MR Mitral regurgitation
MRA Aldosterone receptor antagonists
MRI Magnetic resonance imaging
NYHA New York Heart Association
PCI Percutaneous coronary intervention
PE Pulmonary embolism
PERC Pulmonary embolism rule-out criterion
PPM Permanent pacemaker
RCA Right coronary artery
RV Right ventricle
SAM Systolic anterior motion of mitral valve
SBP Systolic blood pressure
SC Subcutaneously
SCD Sudden cardiac death
SSS Sick sinus syndrome
SVT Supraventricular tachycardia
tPA Tissue plasminogen activator
TAVI Transcatheter aortic valve implantation
TdP Torsades de pointes
TIMI flow grade Thrombolysis in myocardial infarction, it
is used for the assessment of coronary
artery flow in acute coronary syndromes.
[Grade 0 (no flow), grade 1 (penetration
without perfusion), grade 2 (partial per-
fusion), or grade 3 (complete
perfusion)].
UFH Unfractionated heparin