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30 January 2024 : Case report  Colombia

[In Press] Bedside Ultrasound to Guide the Diagnosis and Treatment of Fulminant Right Heart Failure: A Case Report

Challenging differential diagnosis

María Camila Arango-Granados12ABCDEF, Laura Juliana Osorio-González2ABCDEF, Valentina Muñoz-Patiño3CDE

DOI: 10.12659/AJCR.942694

Am J Case Rep In Press; DOI: 10.12659/AJCR.942694  

Available online: 2024-01-30, In Press, Corrected Proof

Publication in the "In-Press" formula aims at speeding up the public availability of the pending manuscript while waiting for the final publication. The assigned DOI number is active and citable. The availability of the article in the Medline, PubMed and PMC databases as well as Web of Science will be obtained after the final publication according to the journal schedule

Abstract

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BACKGROUND
Right ventricular (RV) failure can result from acute or chronic cardiac or pulmonary conditions, or both, resulting in increased afterload, reduced contractility, changes in preload, ventricular interdependence, or dysrhythmias. Notably, increased afterload, particularly among previously healthy individuals, is often the primary cause of RV failure in cases of pulmonary and cardiac origin. Massive pulmonary thromboembolism is a common cause of impending RV failure, and chronic conditions like atrial septal defects can also contribute to pulmonary hypertension.
CASE REPORT
A 72-year-old patient, with no known past medical history, presented to the emergency department in profound shock, rapidly progressing to cardiorespiratory arrest. Bedside ultrasound revealed marked right chambers dilatation, severe mitral and tricuspid insufficiency, a large atrial septal defect, mild pericardial effusion, and global hypokinesia. This case illustrates how multiple mechanisms of RV dysfunction can converge, leading to fulminant RV failure and subsequent cardiac arrest, including increased afterload, decreased contractility, dysrhythmias, and ventricular interdependence.
CONCLUSIONS
This article emphasizes the usefulness of bedside ultrasound in diagnosing and elucidating the causes of circulatory collapse. In this patient, ultrasound played an important role in identifying 3 contributing factors: chronic RV overload from an extensive atrial septal defect, left ventricular impact due to ventricular interdependence, and acute pulmonary thromboembolism. Being aware of these factors, along with the practicality of bedside ultrasound, allowing emergency physicians to make prompt diagnoses and effectively manage RV failure-related emergencies.

Keywords: Atrial Septal Defect 1; Heart Failure; Hypertension, Pulmonary; Pulmonary Embolism

In Press

18 Jan 2024 : Case report  Belgium

A Rare Case of Retroperitoneal Abscess Caused by Nephro-Colic Fistula Resulting from Staghorn Calculus

Am J Case Rep In Press; DOI: 10.12659/AJCR.943206  

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18 Jan 2024 : Case report  USA

A Case of Left-Sided Acute Appendicitis in a 45-Year-Old Man with Situs Inversus Totalis Managed by Emergen...

Am J Case Rep In Press; DOI: 10.12659/AJCR.942323  

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23 Jan 2024 : Case report  USA

Cloacal Dysgenesis Sequence in a Preterm Neonate

Am J Case Rep In Press; DOI: 10.12659/AJCR.942203  

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09 Feb 2024 : Case report  USA

A Case of Trauma-Related Angioedema of the Airway in a Patient on an Angiotensin Receptor Blocker

Am J Case Rep In Press; DOI: 10.12659/AJCR.943407  

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923