Lipomatous Hypertrophy of the Interatrial Septum Manifesting as Third Degree Atrioventricular Block.
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ABSTRACT:
SUBMITTER: Yavar Z
PROVIDER: S-EPMC8299852 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BackgroundLipomatous hypertrophy of the interatrial septum (LHIAS) is a common finding on transthoracic echocardiogram (TTE). Occasionally, the appearance of LHIAS is atypical and multimodality imaging is helpful to make the diagnosis. We present a case of atypical LHIAS to highlight the potential aetiologies for an interatrial septal mass and review features on multimodality imaging that help decrease uncertainty and establish a diagnosis.Case summaryA 64-year-old man with a history of hypertension, diabetes mellitus, and coronary artery disease with multiple percutaneous coronary interventions presented to the emergency room with chest pain. Transthoracic echocardiogram showed a homogenous echo-dense, intracardiac mass present within the interatrial septum. Computed tomography (CT) angiogram of the chest showed a homogenous mass similar in radiodensity to extracardiac and pericardial fat. Cardiac magnetic resonance (CMR) confirmed LHIAS by homogenous signal that was nulled on fat suppression images.DiscussionThis case highlights that while most LHIAS has the standard 'dumbbell' appearance on TTE, there are instances where it can appear more like an adherent mass prompting a wider differential. Unenhanced CT of the heart can be used to confirm LHIAS by the presence of low attenuation values for tissue. Alternatively, CMR can be used for tissue characterization and confirmation of LHIAS. Precontrast T2/T1-weighted CMR images with steady-state free precession show high signal intensity in the area of LHIAS and produce a black/hypointense boundary effect between fat and myocardium. A multimodality approach is crucial in arriving at the appropriate diagnosis using the tissue characterization capabilities of CT and CMR.
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Project description:Asymmetrical left ventricular hypertrophy secondary to interventricular septum hypertrophy is usually considered a typical phenotype of hypertrophic cardiomyopathy. In rare cases other conditions such as tumors or lipomatous hypertrophy of the interventricular septum may have a similar presentation. We present a case of a male patient who presented for routine cardiology work up and was diagnosed of having ventricular septal hypertrophy secondary to localized lipomatous hypertrophy.
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Project description:Third-degree atrioventricular block (AVB) and primary inflammatory myocarditis are uncommon findings in horses. The horse of this report presented for collapse at rest and was found to have multiple cardiac arrhythmias, most notably 3rd-degree AVB. The horse was subsequently diagnosed with eosinophilic myocarditis on necropsy, a rare form of myocarditis not previously reported in horses. Despite extensive testing, an etiologic agent could not be identified, illustrating the difficulty in identifying a specific cause of myocarditis in horses.
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Project description:BackgroundCardiac involvement of Lyme disease (LD) typically results in atrioventricular (AV) conduction disturbance, mainly third-degree AV block.Case summaryA 54-year-old patient presented to our emergency department due to recurrent syncope. Third-degree AV block with a ventricular escape rhythm (33 b.p.m.) was identified as the underlying rhythm. Transthoracic echocardiography (TTE) was normal. To rule out common reversible causes of complete AV block, a screening test for Lyme borreliosis was carried out. Elevated levels for borrelia IgG/IgM were found and confirmed by western blot analysis. Lyme carditis (LC) was postulated as the most likely cause of the third-degree AV block given the young age of the patient. Initiation of antibiotic therapy with ceftriaxone resulted in a gradual normalization of the AV conduction with stable first-degree AV block on Day 6 of therapy. The patient was changed on oral antibiotics (doxycycline) and discharged without a pacemaker. After 3 months, the AV conduction recovered to normal.DiscussionLyme carditis should always be considered, particularly in younger patients with new-onset AV block and without evidence of structural heart disease. Atrioventricular block recovers in the majority of cases after appropriate antibiotic treatment.
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Project description:BackgroundCoronary artery emboli can occur from a number of rare causes such as arterial thrombo-embolus or septic embolus. This diagnosis generally requires multi-modal imaging including echocardiography, computed tomography, or invasive coronary angiography. Septic coronary emboli is an extremely rare consequence of infective endocarditis (IE), having been reported in <1% of all cases.Case summaryA 54-year-old previously healthy Tibetan monk presented feeling generally unwell and lethargic. Electrocardiogram demonstrated sinus rhythm, third-degree atrioventricular block with a left bundle branch escape. Initial transthoracic and transoesophageal echocardiography demonstrated vegetations on the aortic and tricuspid valve as well as intra-myocardial abscess. Coronary angiography revealed septic embolus involving the septal perforator coronary artery. He underwent surgical replacement of the infected valves and debridement and repair of a ventricular septal defect.DiscussionInfective endocarditis can predispose to a range of cardiac pathology. This case demonstrates that patients can present with cardiac conduction disease from a septic embolus involving a coronary artery as a complication of IE.
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Project description:Left bundle branch pacing (LBBP) has proven to be an alternative method for delivering physiological pacing to achieve electrical synchrony of the left ventricle (LV), especially in patients with atrioventricular block and left bundle branch block (LBBB). However, it is unclear whether it still achieved in patients whose left bundle branch (LBB) has had surgery-induced damage. The Morrow operation (Morrow septal myectomy) is regarded as one of the most effective treatments for hypertrophic obstructive cardiomyopathy (HOCM). The surgery resects small sections of muscle tissue in the proximal ventricular septum nearby or contains the LBB, which means that physical damage to the LBB is almost inevitable. Approximately 2%-12% of patients may need pacemaker implanted after Morrow surgery. LBBP is a feasible and effective method for achieving electric resynchronization of LBBB compared to right ventricular pacing (RVB). Nevertheless, there is a dearth of data on LBBP in third-degree atrioventricular block (AVB) following Morrow surgery. We report a case of successful LBBP in those patients.
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Project description:Lyme disease is the most common tick-borne illness in the United States due to Borrelia burgdorferi infection. This case demonstrates a 20-year-old male patient presenting with complaints of annular skin rash, malaise, fever, and lightheadedness after significant outdoor exposure. Physical exam revealed multiple large targetoid lesions on the back and extremities. The rash had raised borders and centralized clearing consistent with erythema migrans chronicum. Electrocardiogram (ECG) revealed a high-degree atrioventricular (AV) block. The patient was started on intravenous ceftriaxone due to clinical suspicion for Lyme carditis. ELISA and Western blot tests were reactive for Lyme IgM and IgG, confirming the diagnosis. The AV block resolved by hospital day four and the patient was discharged with outpatient follow-up. Early identification of disease allowed for effective treatment with no adverse outcomes or sequelae.
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Project description:BackgroundTakotsubo cardiomyopathy (TCM) can clinically present as an acute coronary syndrome; however, the former has regional wall motion abnormalities that extend beyond a single coronary vascular territory without any plaque rupture. Takotsubo cardiomyopathy classically involves apical ballooning of left ventricle (LV). It is uncommon for TCM to present as cardiopulmonary arrest (CPA) along with third-degree atrioventricular (AV) block.Case summaryA 63-year-old female, underwent a ventricular fibrillation (VF) CPA. She was defibrillated three times and return of spontaneous circulation (ROSC) was achieved after 37 min. Her post-ROSC electrocardiogram showed non-specific ST-segment changes and T-wave inversions and soon progressed to third-degree AV block. Patient had a transvenous pacemaker placed to pace her heart. Echocardiogram showed an LV ejection fraction of 15-20% with akinesis of the apex and anteroseptum. An echocardiogram repeated 4 days after the cardiopulmonary arrests showed an ejection fraction of 60-65% with hypokinesis of mid anterior and antero-apical hypokinesis. However, the patient still continued to require a pacemaker and hence eventually received a dual-chamber pacemaker/implantable cardioverter-defibrillator for her AV block and ventricular arrhythmia.DiscussionMost commonly TCM presents with chest pain and symptoms of acute myocardial infarction. We present a very rare presentation of TCM associated with VF and CPA along with third-degree AV block. There have handful of case reports documenting TCM causing CPA in some patients and other case reports showing TCM causing high degree AV block. In our patient, TCM was associated with both VF and CPA along with third-degree AV block.
| S-EPMC8183658 | biostudies-literature