Severe stenosis or occlusion of the subclavian artery is a rare clinical finding, even more so for bilateral existence of the condition. Subclavian artery stenosis and occlusion leads to erroneously low blood pressure values when measured at the brachial artery on the ipsilateral side. Widespread clinical reliance on a sole brachial measurement of blood pressure, particularly in the emergency room setting, may result in inappropriate clinical management in patients with conditions that alter brachial blood pressure. Currently, there is no published English-language literature on the implications of bilateral subclavian artery stenosis and occlusion in heart failure. A case of an apparently hypotensive patient with frequent emergency room visits for symptoms of heart failure exacerbation is presented. La sténose grave ou l'occlusion de l'artère sous-clavière est une observation clinique rare et encore plus lorsque la maladie se manifeste bilatéralement. La sténose et l'occlusion sous-clavières entraînent des valeurs de tension artérielle faussement basses lorsqu'on les mesure au niveau de l'artère brachiale ipsilatérale. En clinique, comme on se fie uniquement à la mesure de la tension artérielle brachiale dans la plupart des cas, et particulièrement dans les services d'urgences, la prise en charge clinique pourrait s'en trouver inappropriée chez les patients qui souffrent d'une maladie susceptible de fausser la mesure de la tension artérielle brachiale. Rien n'a encore été publié en langue anglaise sur les implications de la sténose et de l'occlusion bilatérales de l'artère sous-clavière dans l'insuffisance cardiaque. On présente ici le cas d'un patient en apparence hypotendu qui s'est présenté à l'urgence à de multiples reprises pour des symptômes d'exacerbation de son insuffisance cardiaque.S evere stenosis or occlusion of the subclavian artery is a rare clinical finding, even more so for bilateral existence of the condition (1-3). Subclavian artery stenosis and occlusion leads to erroneously low blood pressure values when measured at the brachial artery on the ipsilateral side. Widespread clinical reliance on a sole brachial measurement of blood pressure, particularly in the emergency room (ER) setting, may result in inappropriate clinical management in patients with conditions that alter brachial blood pressure. To the best of our knowledge, there is no published English-language literature on the implications of bilateral subclavian artery stenosis and occlusion in heart failure. A case of an apparently hypotensive patient with frequent ER visits for symptoms of heart failure exacerbation is presented. CASe PreSentAtiOnA 71-year-old woman with known diastolic congestive heart failure (CHF) presented to the ER with exacerbation of CHF and a decreased level of consciousness. Brachial blood pressure (BP) was measured at 55/40 mmHg. The patient had four recent admissions with exacerbation of CHF. Her medical history was also significant for autoimmune hepatitis, but preserved liver function; esophageal varices ...
A 57-year-old man presented to the emergency department with peripheral edema. Findings on physical examination were consistent with atrial fibrillation, tricuspid regurgitation, and heart failure on the right side. A radiograph of the chest showed a high cardiothoracic ratio of 0.82 and a very large right atrium (RA; Panel A). Transthoracic echocardiography (Fig. S1 in the Supplementary Appendix, available at NEJM.org), cardiac computed tomography (Panel B, and Figs. S2 and S3 in the Supplementary Appendix), and cardiac magnetic resonance imaging (Fig. S4 in the Supplementary Appendix) revealed a giant right atrium, a dilated right ventricle (RV) with preserved systolic function, grade 4/4 functional tricuspid regurgitation, high-normal right-ventricular systolic pressure, and normal size and function of the left ventricle (LV). LA denotes left atrium. No shunt was identified. Medical therapy, including oral anticoagulation for atrial fibrillation, was initiated, with good response, and the patient's condition remained stable 1 year after presentation. Giant right atrium is a rare congenital condition that causes functional tricuspid regurgitation and heart failure on the right side. It is usually diagnosed in childhood. Other, more common causes of right atrial enlargement such as pulmonary hypertension, tricuspidvalve stenosis, and Ebstein's anomaly were not identified in our patient.
Background Spontaneous coronary artery dissection (SCAD) has gained attention as an important cause of acute coronary syndrome and sudden cardiac death (SCD) among women. Management strategies of SCAD differ from those of atherosclerotic disease. There is an elevated risk of complications and suboptimal outcomes in patients with SCAD undergoing percutaneous coronary interventions (PCIs). Case summary A 48-year-old woman without any traditional cardiovascular risk factors was admitted with severe central chest pain with associated dyspnoea and diaphoresis. The patient had a strong family history of SCD, affecting three female members in their 40s and 50s. Cardiac troponins were elevated. Coronary angiogram showed moderate to severe stenosis of the proximal circumflex coronary artery. Optical coherence tomography confirmed SCAD with sub-intimal haematoma. Despite significant stenosis in the proximal segment of a relatively large artery, a decision was made not to proceed with PCI. The follow-up angiogram demonstrated normal coronaries. Magnetic resonance imaging of renal arteries showed features suggestive of fibromuscular dysplasia affecting the right renal artery. Subsequent genetic counselling and gene testing were unremarkable. Discussion Conservative management of SCAD is recommended because the large majority of SCAD lesions heal naturally, whereas PCI is associated with increased risk of complications and adverse outcomes. Whether SCAD is associated with the sudden death events in our patient’s family remains unclear. It certainly raises concerns as to an inheritable condition. In the absence of post-mortem findings in her family members, we can only speculate about this representing a possible inheritable form of SCAD.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.