CAR-2. An 18 year-old in a 78 year-old body: an unusual case of lightheadedness.A 78-year-old woman presented for evaluation of recurrent episodes of lightheadedness and shortness of breath Shortness of Breath Definition Shortness of breath, or dyspnea, is a feeling of difficult or labored breathing that is out of proportion to the patient's level of physical activity. . She described her symptoms as a sudden onset of lightheadedness, which occurred with walking and cleaning her house. She denied associated chest pain, orthopnea, or paroxysmal nocturnal dyspnea paroxysmal nocturnal dyspnea n. Abbr. PND Acute dyspnea caused by the lung congestion and edema that results from partial heart failure and occurring suddenly at night, usually an hour or two after the individual has fallen asleep. . Past medical history was positive for remote deep venous thrombosis deep venous thrombosis n. Abbr. DVT A condition in which one or more thrombi form in a deep vein, especially in the leg or pelvis, resulting in an increased risk of pulmonary embolism. , hypertension, and hyperlipidemia; negative for coronary artery disease coronary artery disease, condition that results when the coronary arteries are narrowed or occluded, most commonly by atherosclerotic deposits of fibrous and fatty tissue. , diabetes mellitus, or smoking. On physical examination, blood pressure was 134/82 (without orthostatic change), pulse 64, respirations 12. She was afebrile. Cardiac examination was normal and lung sounds were clear. Abdomen was benign without mass or bruit bruit (brwe) (brldbomact) 1. a sound or murmur heard in auscultation, especially an abnormal one. 2. sound (3). . Arterial pulses in the extremities were normal and no cyanosis cyanosis (sī'ənō`sĭs), bluish coloration of the skin, mucous membranes, and nailbeds, resulting from a lack of oxygenated hemoglobin in the blood. , clubbing, or edema was noted. Electrocardiogram performed at presentation showed normal sinus rhythm with normal PR and QT intervals. Exercise echocardiogram to 2.8 METS induced no wall motion abnormalities and ejection fraction improved with stress. The examination, however, was terminated due to lightheadedness and ventricular tachycardia, resolved with rest. No significant coronary artery disease was discovered on cardiac catheterization. The right coronary artery (RCA) was noted to arise from the left coronary cusp. CT angiography visualized compression of the RCA between the aorta and right pulmonary artery, due to its anomalous origin. Ultimately, the patient underwent coronary artery bypass Coronary artery bypass Surgical procedure to reroute blood around a blocked coronary artery. Mentioned in: Heart Failure coronary artery bypass, n utilizing right internal mammary artery to proximal right coronary artery, without recurrent symptoms 6 months after surgery. Anomalous coronary artery anatomy (ACAA) is a relatively rare finding, occurring in 0.3-0.8% of the population. The significance of ACAA is its ability to induce life-threatening arrhythmias, typically in young athletes. This case illustrates the potential of congenital anatomic etiologies to induce ventricular arrhythmias in patients of any age, including the elderly. Michael B. Phillips, MD. Department of Internal Medicine, Mayo Clinic, Jacksonville, FL. |
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