Rare presentation of atrial myxoma: chest pain, dysphagia and left upper extremity weakness

Atrial myxoma is a benign primary heart tumour, which can be found incidentally on imaging studies. It is usually located in the left atrium and may manifest as dyspnoea, chest pain, heart failure, cough, shortness of breath when rising from a recumbent position, haemoptysis, hoarseness and as a source of cardiac embolism. However, dysphagia caused by an atrial myxoma has been reported only twice in the literature. We present a 53-year-old Caucasian man with a chronic history of dysphagia caused by an atrial myxoma, in which surgical resection resulted in complete resolution of his dysphagia.

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A young patient with heart failure – picture Quiz Question

Acute Medicine Journal ◽

10.52964/amja.0539 ◽

2012 ◽

Vol 11 (1) ◽

pp. 28-28

Author(s):

H Patel ◽

◽

G Dhillon ◽

A Bandali ◽

Neil Patel ◽

...

Keyword(s):

Heart Failure ◽

Case Report ◽

Chest Pain ◽

Young Patient ◽

Loss Of Consciousness ◽

Productive Cough ◽

Shortness Of Breath ◽

Pleuritic Chest Pain ◽

History Of

Case report A 28 year old gentleman presented after an episode of collapse with loss of consciousness. He gave a history of non-specific malaise and myalgia over the previous 7 days, with fever, a generalised rash and a non productive cough. He developed progressive shortness of breath with sharp, pleuritic chest pain that was unresponsive to antibiotics in the community.

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Derivation of a clinical decision rule for chest radiography in emergency department patients with chest pain and possible acute coronary syndrome

CJEM ◽

10.1017/s148180350001215x ◽

2010 ◽

Vol 12 (02) ◽

pp. 128-134 ◽

Cited By ~ 7

Author(s):

Erik P. Hess ◽

Jeffrey J. Perry ◽

Pam Ladouceur ◽

George A. Wells ◽

Ian G. Stiell

Keyword(s):

Heart Failure ◽

Emergency Department ◽

Congestive Heart Failure ◽

Chest Pain ◽

Chest Radiography ◽

Clinical Decision ◽

Chest Radiographs ◽

Clinical Decision Rule ◽

Coronary Syndrome ◽

History Of

ABSTRACTObjective:We derived a clinical decision rule to determine which emergency department (ED) patients with chest pain and possible acute coronary syndrome (ACS) require chest radiography.Methods:We prospectively enrolled patients over 24 years of age with a primary complaint of chest pain and possible ACS over a 6-month period. Emergency physicians completed standardized clinical assessments and ordered chest radiographs as appropriate. Two blinded investigators independently classified chest radiographs as “normal,” “abnormal not requiring intervention” and “abnormal requiring intervention,” based on review of the radiology report and the medical record. The primary outcome was abnormality of chest radiographs requiring acute intervention. Analyses included interrater reliability assessment (with κ statistics), univariate analyses and recursive partitioning.Results:We enrolled 529 patients during the study period between Jul. 1, 2007, and Dec. 31, 2007. Patients had a mean age of 59.9 years, 60.3% were male, 4.0% had a history of congestive heart failure and 21.9% had a history of acute myocardial infarction. Only 2.1% (95% confidence interval [CI] 1.1%–3.8%) of patients had radiographic abnormality of the chest requiring acute intervention. The κ statistic for chest radiograph classification was 0.81 (95% CI 0.66–0.95). We derived the following rule: patients can forgo chest radiography if they have no history of congestive heart failure, no history of smoking and no abnormalities on lung auscultation. The rule was 100% sensitive (95% CI 32.0%–10.4%) and 36.1% specific (95% CI 32.0%–40.4%).Conclusion:This rule has potential to reduce health care costs and enhance ED patient flow. It requires validation in an independent patient population before introduction into clinical practice.

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Development of new cold antibodies in a patient with a history of warm autoimmune haemolytic anaemia

BMJ Case Reports ◽

10.1136/bcr-2019-232224 ◽

2020 ◽

Vol 13 (6) ◽

pp. e232224 ◽

Cited By ~ 1

Author(s):

Meghan Anderson ◽

Megan Winter ◽

Vinicius Jorge ◽

Claudia Dourado

Keyword(s):

Chest Pain ◽

Haemolytic Anaemia ◽

Acute Treatment ◽

Autoimmune Disorder ◽

Shortness Of Breath ◽

History Of ◽

Mixed Pattern ◽

Lost To Follow Up ◽

Record Review

A 31-year-old male presented to our facility with complaints of shortness of breath and left-sided chest pain. On record review, it was revealed that he had been seen in 2014 for an almost identical presentation and had been found to have haemolytic anaemia with warm autoantibodies. Following his acute treatment during that hospital admission, he was lost to follow-up. During his subsequent admission, 5 years later, he was found to have a systemic autoimmune disorder with a superimposed acute bacterial infection leading to a second case of haemolytic anaemia and at this time with both cold and warm antibodies present. While his diagnosis was initially difficult to make due to both derangements in expected laboratory values and the mixed pattern of the haemolytic anaemia, he was promptly treated with intravenous immune globulin and steroids and was able to make a full recovery.

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P1829 A middle aged man with pericardial cyst

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.1172 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

A Kandil ◽

R Nata ◽

P Felix

Keyword(s):

Heart Failure ◽

Left Ventricular ◽

Maximum Diameter ◽

Heavy Smoker ◽

X Rays ◽

Shortness Of Breath ◽

Pericardial Cyst ◽

History Of ◽

Pericardial Cysts ◽

The Right

Abstract Introduction Pericardial cysts are rare benign congenital anomaly that are usually accidentally discovered as a mass obliterating the costophrenic angle. The reported incidence is one to 100,000 with males are equally affected as females. They are usually asymptomatic; however, they can cause chest pain, shortness of breath and dry cough. Case report We present a 62 years old gentleman who presented with increasing shortness of breath. He was a heavy smoker and was known to have COPD. He was also known to have chronic heart failure with an EF of 40% and had a previous history of pericardial cyst that was initially discovered when he was investigated for shortness of breath. The patient had a one-month history of feeling more dyspneic than usual. His chest auscultation revealed scattered rhonchi and no murmurs were heard on auscultation of the heart. His ECG showed no new abnormality and his chest x-ray showed abnormal right cardio mediastinal silhouette with large opaque area adjacent to the right heart border and the size of the opacity the same compared to his previous x rays. An Echocardiography was done and this showed moderate to severe impairment of left ventricular systolic function with an EF of 30-35%, mild to moderate mitral regurgitation and showed a cystic lesion anterior to the right ventricle. A CT chest was done for evaluation of the pericardial cyst and showed centrilobular emphysema and a mass in the rt lung abutting the right border of the heart with a maximum diameter of 8.7 cm. The patient was non-compliant to his medications and repeatedly missed his follow up appointments. He also continued to smoke despite progression of his COPD. The cause of his shortness of breath was likely due to progression of heart failure and COPD with the pericardial cyst probably has no or minimal rule. Conclusion Pericardial cysts are rarely symptomatic and usually has a benign course. We aimed at increasing awareness of this rare benign animally. Abstract P1829 Figure.

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Just the Facts: Protected code blue – Cardiopulmonary resuscitation in the emergency department during the coronavirus disease 2019 pandemic

CJEM ◽

10.1017/cem.2020.379 ◽

2020 ◽

Vol 22 (4) ◽

pp. 431-434 ◽

Cited By ~ 3

Author(s):

Sarah McIsaac ◽

Randy S. Wax ◽

Brit Long ◽

Christopher Hicks ◽

Christian Vaillancourt ◽

...

Keyword(s):

Patient Outcome ◽

Emergency Department ◽

Chest Pain ◽

Cardiopulmonary Resuscitation ◽

Emergency Medical Services ◽

Negative Pressure ◽

Shortness Of Breath ◽

Code Blue ◽

Palpable Pulse ◽

History Of

Emergency medical services (EMS) is called for a 65-year-old man with a 1-week history of cough, fever, and mild shortness of breath now reporting chest pain. Vitals on scene were HR 110, BP 135/90, SpO2 88% on room air. EMS arrives at the emergency department (ED). As the patient is moved to a negative pressure room, he becomes unresponsive with no palpable pulse. What next steps should be discussed in order to protect the team and achieve the best possible patient outcome?

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Validation of a Decision Rule and Derivation of a Modified Rule to Obtain Chest Radiograph in Patients with Nontraumatic Chest Pain in the Emergency Department

Advances in Emergency Medicine ◽

10.1155/2014/241935 ◽

2014 ◽

Vol 2014 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Case Newsom ◽

Rebecca Jeanmonod ◽

Karl Weller ◽

Nabil Boutros ◽

Mark Reiter ◽

...

Keyword(s):

Heart Failure ◽

Emergency Department ◽

Congestive Heart Failure ◽

Chest Pain ◽

Alcohol Abuse ◽

Decision Rule ◽

Predictive Value ◽

Breath Sounds ◽

History Of ◽

Sensitivity Specificity

Objectives. We sought to validate and refine a decision rule for chest X-ray (CXR) utilization in nontraumatic chest pain (CP) patients presenting to the emergency department (ED). Methods. Retrospective review of ED patients presenting with CP who had CXR performed during three nonconsecutive months was performed. The presence of 18 variables derived from history and exam was ascertained. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the original rule were calculated. Refinement using additional variables was performed. Results. 967 patient charts were reviewed. 89.9% of CXR were normal, 5.2% had insignificant findings, and 5.1% had significant findings. Application of the criteria had a sensitivity/specificity of 74%/59% and a PPV/ NPV of 9%/98%. Rule modification to obtain CXR for age ≥ 65 years, history of congestive heart failure and alcohol abuse, and exam findings of decreased breath sounds, fever, and tachypnea maintained sensitivity while improving specificity to 69%. Conclusions. Most CP patients have normal CXRs. Narrowing a decision rule to obtain CXR in patients with age ≥ 65 years, history of congestive heart failure and alcohol abuse, and exam findings of decreased breath sounds, fever, and tachypnea maintain sensitivity while improving specificity and NPV.

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Innovative use of mesh bolster for adult Morgagni hernia repair

Journal of Surgical Case Reports ◽

10.1093/jscr/rjz205 ◽

2019 ◽

Vol 2019 (7) ◽

Cited By ~ 1

Author(s):

Nabiel Azar ◽

Robert Azar ◽

Katie Robertson ◽

Priya Gupta

Keyword(s):

Chest Pain ◽

Hernia Repair ◽

Congenital Diaphragmatic Hernia ◽

Shortness Of Breath ◽

Morgagni Hernia ◽

Adult Case ◽

Rare Type ◽

Lack Of Fusion ◽

Large Size ◽

History Of

AbstractMorgagni hernia is a rare type of congenital diaphragmatic hernia caused by lack of fusion of the pleuroperitoneal membrane anteriorly leading to a defect in the foramen of Morgagni. These are rare hernias and typically present early in life. Those that do not get repaired during infancy or adolescence often present later in life with variable symptoms including obstruction, incarceration, strangulation, pulmonary symptoms, chest pain, etc. Herein we present an adult case that was found incidentally after a screening computerized tomography (CT) chest scan was done for history of smoking. There are two unique aspects to this case: first, given the large size of her hernia, her only complaint was mild shortness of breath and second, the innovative use of mesh as a suture bolster.

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Orthopnea and fever in an elderly woman

Italian Journal of Medicine ◽

10.4081/itjm.2017.922 ◽

2017 ◽

Vol 11 (4) ◽

pp. 399

Author(s):

Claudio Tana ◽

Silvio Di Carlo ◽

Mauro Silingardi ◽

Maria Adele Giamberardino ◽

Francesco Cipollone ◽

...

Keyword(s):

Emergency Department ◽

Low Back Pain ◽

Back Pain ◽

Elderly Woman ◽

Surgical Repair ◽

Low Back ◽

Shortness Of Breath ◽

Recumbent Position ◽

Radiological Findings ◽

History Of

Orthopnea is a sensation of shortness of breath, which occurs in recumbent position and is usually improved by standing or sitting. The authors report a case of an 81-year-old woman presented to the Emergency Department with a two-week history of orthopnea, fever and low back pain resistant to analgesics. Radiological findings confirm the presence of a diafragmatic hernia, and clinicians should pay attention to any history of trauma, because their absence in symptomatic adult patients directs towards a congenital cause. A surgical repair should be promptly obtained to avoid further general and respiratory deterioration.

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Atypical Hemolytic Uremic Syndrome Presenting as Acute Heart Failure—A Rare Presentation: Diagnosis Supported by Skin Biopsy

Journal of Investigative Medicine High Impact Case Reports ◽

10.1177/2324709619842905 ◽

2019 ◽

Vol 7 ◽

pp. 232470961984290

Author(s):

Asim Kichloo ◽

Savneek Singh Chugh ◽

Sanjeev Gupta ◽

Jay Pandav ◽

Praveen Chander

Keyword(s):

Heart Failure ◽

Skin Biopsy ◽

Hemolytic Uremic Syndrome ◽

Thrombotic Microangiopathy ◽

Atypical Hemolytic Uremic Syndrome ◽

Systolic Heart Failure ◽

Kidney Injury ◽

Rare Presentation ◽

History Of ◽

Uremic Syndrome

Atypical hemolytic uremic syndrome (aHUS) is a rare disorder of uncontrolled complement activation that manifests classically as anemia, thrombocytopenia, and renal failure, although extrarenal manifestations are observed in 20% of the patient most of which involving central nervous system, with relatively rare involvement of the heart. In this article, we report the case of a 24-year-old male with no history of heart disease presenting with acute systolic heart failure along with microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury. Given his presentation of thrombotic microangiopathy (TMA), along with laboratory results significant for low haptoglobin, platelets, hemoglobin, C3, C4, CH50, and normal ADAMTS13 levels, with no diarrhea and negative STEC polymerase chain reaction in stool, aHUS diagnosis was established with strong clinical suspicion, and immediate initiation of treatment was advised. Kidney biopsy to confirm diagnosis of aHUS was inadvisable because of thrombocytopenia, so the skin biopsy of a rash on his arm was done, which came to be consistent with thrombotic microangiopathy. Our case highlights a relatively rare association between aHUS and cardiac involvement, and the use of skin biopsy to support diagnosis of aHUS in patients who cannot undergo renal biopsy because of thrombocytopenia.

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Isolated Interrupted Aortic Arch: Unexpected Diagnosis in a 63-Year-Old Male

Case Reports in Critical Care ◽

10.1155/2011/989621 ◽

2011 ◽

Vol 2011 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Hassan Javadzadegan ◽

Jahan Porhomayon ◽

Alireza Sadighi ◽

Mehrdad Yavarikia ◽

Nader Nader

Keyword(s):

Heart Failure ◽

Blood Pressure ◽

Chest Pain ◽

Aortic Arch ◽

Aortic Root ◽

Interrupted Aortic Arch ◽

Advanced Heart Failure ◽

Arterial Blood ◽

Brachiocephalic Trunk ◽

History Of

A 63-year-old male with history of hypertension, dyspnea on exertion, and chronic chest pain was admitted for elective cardiac angiography. Arterial blood pressure was 160/90 mmHg in both arms. Femoral and popliteal pulses were extremely weak, and third (S3) and fourth (S4) heart sounds were audible. Aortography showed a mildly dilated aortic root with double brachiocephalic trunk and interruption of aortic arch at isthmus. Profuse and well-developed collaterals appeared at neck and thorax. The patient was recommended to take medical treatment for his hypertension and advanced heart failure. The aim of this paper, is to review the diagnostic and therapeutic options for treatment of the interrupted aortic arch.

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