Yashitha Chirumamilla, Ajit Brar, Farouk Belal, Philip McDonald
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引用次数: 0
Abstract
A 56-year-old African American female was under evaluation for coronary artery disease by a cardiologist due to her complaints of intermittent chest pain. She underwent an outpatient echocardiogram and was found to have an ejection fraction of 20-25% with global left ventricular hypokinesis. Due to this finding along with her ongoing chest pain, she was referred to the emergency department for further evaluation. Her electrocardiogram showed changes suggestive of ischaemia and her cardiac troponins were mildly elevated, so she underwent an urgent cardiac catheterisation. The angiography confirmed the reduced ejection fraction and global left ventricular hypokinesis, but also demonstrated a large coronary cameral fistula (CCF) extending from the first septal branch into the left ventricle. She was then diagnosed with non-ischaemic cardiomyopathy and heart failure with reduced ejection fraction secondary to the CCF. In this report, we illustrate a frequently encountered clinical scenario in which a patient presented with chest pain and EKG findings indicative of ischaemic cardiomyopathy. The patient also had several risk factors for coronary artery disease, however further investigation revealed an alternative diagnosis.
Learning points: A description of rare coronary anomalies adds to the fund of medical knowledge and can guide physicians to make evidence-based decisions regarding its management.Increasing description of coronary cameral fistula will alert clinicians to suspect it as a cause for worsening heart failure and as a treatable cause of non-ischaemic cardiomyopathy.
期刊介绍:
The European Journal of Case Reports in Internal Medicine is an official journal of the European Federation of Internal Medicine (EFIM), representing 35 national societies from 33 European countries. The Journal''s mission is to promote the best medical practice and innovation in the field of acute and general medicine. It also provides a forum for internal medicine doctors where they can share new approaches with the aim of improving diagnostic and clinical skills in this field. EJCRIM welcomes high-quality case reports describing unusual or complex cases that an internist may encounter in everyday practice. The cases should either demonstrate the appropriateness of a diagnostic/therapeutic approach, describe a new procedure or maneuver, or show unusual manifestations of a disease or unexpected reactions. The Journal only accepts and publishes those case reports whose learning points provide new insight and/or contribute to advancing medical knowledge both in terms of diagnostics and therapeutic approaches. Case reports of medical errors, therefore, are also welcome as long as they provide innovative measures on how to prevent them in the current practice (Instructive Errors). The Journal may also consider brief and reasoned reports on issues relevant to the practice of Internal Medicine, as well as Abstracts submitted to the scientific meetings of acknowledged medical societies.