Aortic dissection

 Nice case from Dr. Smith's Blog - ECG pattern not infrequently seen 

Case Presentation 12-15-2022

A 77-year-old male saw his PCP for commercial driver's license presented with abdominal bloating and nausea.  He was found to be initially in SVT with HR = 150 (EKG below) , received Cardizem IV bolus and drip . He was found to be in renal failure with BUN of 46 creatinine of 2.6. Hepatitis A and B and C diagnostic studies were ordered. CT A/P was ordered ( see below) and an MRCP (??). No POCUS exam was done.

Patient does take naturopathic medications .

However it appears that the patient did not realize that he was in a rapid HR and may have developed tachycardia induced cardiomyopathy with severe right heart failure symptoms causing the above liver function kidney function abnormalities (CRS).

Blood pressure 127/69 heart rate 98 bpm saturation 94 respirations 22

Cardiology has been consulted.

CT abdomen pelvis showed no acute intra abdominal abnormalities.  Small volume of ascites, small left and tiny right pleural effusions.  There was however cardiomegaly.

NT proBNP 12,900.

Strongly suspect tachycardia induced cardiomyopathy , R/O ATTR amyloidosis ( is there a history of CTS) or even constrictive pericarditis (less likely for CT A/P)  given evidence of right heart failure symptoms .( if there is a unifying cardiac process that is)

What is your differential diagnosis. What is your possible short-term and long term diagnostic and treatment plan?

ForeFront2022.com

Management PVC's

Management of premature ventricular complexeshttps://t.co/3drhZM9G5n pic.twitter.com/3IhjMwV46U

— Heart_BMJ (@Heart_BMJ) April 27, 2022