Abstract 14455: Hidden in Plain Sight: An Elusive Cause of Cardiogenic Shock
| العنوان: | Abstract 14455: Hidden in Plain Sight: An Elusive Cause of Cardiogenic Shock |
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| المؤلفون: | Fei Li Kuang, Karlyn Martin, Sarah Chuzi, Benjamin H. Freed, Anjan Tibrewala, Esther Vorovich, Sadiya S. Khan, Jon W. Lomasney |
| المصدر: | Circulation. 142 |
| بيانات النشر: | Ovid Technologies (Wolters Kluwer Health), 2020. |
| سنة النشر: | 2020 |
| مصطلحات موضوعية: | medicine.medical_specialty, COPD, Orthopnea, Myocarditis, medicine.diagnostic_test, business.industry, Cardiogenic shock, Physical examination, medicine.disease, Chest pain, Physiology (medical), Internal medicine, Heart failure, cardiovascular system, medicine, Cardiology, cardiovascular diseases, Exertion, medicine.symptom, Cardiology and Cardiovascular Medicine, business |
| الوصف: | A 54-year-old man with chronic obstructive pulmonary disease (COPD) presented with three days of chest pain, dyspnea on exertion, and orthopnea. Physical examination revealed jugular venous distention and lower extremity edema. Cardiac biomarkers were elevated. The differential diagnosis for the clinical presentation included: acute coronary syndrome, and type II myocardial infarction or myocardial injury due to acute decompensated heart failure. External records demonstrated recurrent admissions for similar signs and symptoms, with negative coronary angiogram. Shortly after admission, the patient developed acute cardiogenic shock requiring venoarterial extracorporeal membrane oxygenation. Echocardiogram revealed biventricular failure and a possible mitral valve vegetation. The differential diagnosis was refined to include myocarditis (infectious and noninfectious causes), bacterial versus marantic endocarditis, and infiltrative cardiomyopathies. Transesophageal echocardiography revealed mass-like, bileaflet thickening of the mitral valve, not consistent with true vegetation. Infectious, rheumatologic, and hypercoagulable workups were negative. Given the lack of a unifying diagnosis, a right ventricular (RV) endomyocardial biopsy was pursued. This revealed myocardial necrosis and fibrosis, and a mural thrombus with extensive eosinophils. The primary data was then revisited, which revealed history of peripheral eosinophilia that was intermittently suppressed by steroids given for COPD. Cardiac magnetic resonance imaging (MRI) demonstrated diffuse biventricular subendocardial late gadolinium enhancement and RV thrombi. Evaluation for underlying causes of eosinophilia was negative leading to the diagnosis of Loeffler’s endocarditis due to idiopathic hypereosinophilic syndrome. This case demonstrates: (1) the important role of cardiac MRI in the evaluation of both unexplained myocardial injury and new cardiomyopathy, (2) a rare case of Loeffler’s endocarditis requiring mechanical circulatory support, and (3) the consequences of both availability bias and failure to fully “unpack” the primary diagnostic data, which rendered the true etiology of the patient’s cardiogenic shock “hidden in plain sight.” |
| تدمد: | 1524-4539 0009-7322 |
| DOI: | 10.1161/circ.142.suppl_3.14455 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_________::1bfd02e5511e2ade7c7c93bd08891e79 https://doi.org/10.1161/circ.142.suppl_3.14455 |
| رقم الانضمام: | edsair.doi...........1bfd02e5511e2ade7c7c93bd08891e79 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 15244539 00097322 |
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| DOI: | 10.1161/circ.142.suppl_3.14455 |