2020
Permanent URI for this communityhttps://hdl.handle.net/20.500.12503/29915
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Browsing 2020 by Author "Aftabizadeh, Som"
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Item Acute Pericarditis Caused by Pulmonary Embolism: A Dressler-Like Syndrome(2020) Gabbert, Brittany; Aftabizadeh, SomPericarditis presenting as a sequelae of myocardial infarction, pericardiotomy or chest trauma is well recognized; but it is rarely described in association with pulmonary embolism. A 40 year old caucasian male with no significant past medical history presented with new-onset shortness of breath and substernal chest pain worsening over the preceding three days. He is a never smoker. One week prior he drove to Texas from Colorado. The main differential diagnosis based off the history was pulmonary embolism, acute coronary syndrome, pleurisy and musculoskeletal chest pain. Electrocardiogram showed sinus tachycardia with S1Q3T3. Chest CTA showed a saddle embolus and evidence of right ventricular strain. Transthoracic echocardiogram showed markedly dilated right ventricle with mild hypokinesis of the mid free wall and McConnell's sign. EKOS catheter was then placed for 12 hours. The patient improved and was discharged on an oral anticoagulant with scheduled outpatient follow-up. One week later he presented to our ER with chest pain radiating to the back. A friction rub was present on cardiac auscultation. EKG showed normal sinus rhythm with diffuse ST elevation, PR depression and Spodick's sign. Troponin levels were negative, TTE showed improved RV strain and preserved LV function. CRP and ESR were significantly elevated. He was diagnosed with pericarditis and started on indomethacin and colchicine. Pulmonary embolism can cause right heart strain via increased pulmonary vascular pressures. This strain can lead to transmural infarction in the right heart which can then lead to acute pericarditis.Item Takotsubo cardiomyopathy caused by COPD exacerbation(2020) Aftabizadeh, SomTakotsubo cardiomyopathy is characterized by transient left ventricular dysfunction that may be associated with emotional or physical triggers. We present the case of a 57-year-old female with severe COPD who presented with syncope and was found to have stress-induced cardiomyopathy. TCM associated with COPD is a rare and raises the possibility of a common underlying mechanism. A 57-year-old female presented to the ER with respiratory failure after she was found unresponsive. Her past medical history included severe COPD, hypertension, and active tobacco abuse. Her EKG on arrival showed sinus tachycardia and PR segment depression as well as repolarization abnormalities in inferior leads. Labs were significant for elevated BNP and troponemia. An TTE on admission revealed severely reduced LV systolic function and severe diffuse LV hypokinesis. A toxicology screen was notably negative for cocaine. She was treated for COPD exacerbation and NSTEMI and improved over the course of the next three days. Coronary angiography revealed non-obstructive coronary artery disease. Repeat TTE four days after admission showed her LV dysfunction had resolved. TCM is characterized by reversible LV dysfunction that is unrelated to obstructive CAD. While rare, literature of review shows several cases of TCM have been associated with both COPD and asthma exacerbation. With catecholamines playing a key role to the pathogenesis of the disease, beta-adrenergic stimulation may be a potential trigger. Some sources speculate that the disproportionate predominance of sympathetic over parasympathetic activity during a COPD exacerbation could be a trigger for TCM.