Jon-Emile S. Kenny MD [@heart_lung] with illustrations by Carla M Canepa MD [@_carlemd_] “The habit of writing for my eye is good practice. It loosens the ligaments.” ― Virginia Woolf Case A 28 year old woman with known severe mitral stenosis from rheumatic heart disease presents with acute onset shortness of breath. Her acute dyspnea began while walking out of the airport following a 12-hour flight. She is taking oral contraceptive pills and notes pleuritic chest pain in the emergency department, she also endorses one week of chills with a non-productive cough. Her heart rate is 145 beats per minute and irregular with a blood pressure of 102/88, an oxygen saturation of 90% and a low-grade fever. An ECG reveals atrial fibrillation and a CT angiogram is performed to evaluate for pulmonary embolus. A peripheral wedge-shaped opacity is noted distal to a small, sub-segmental pulmonary embolus. In the contralateral lung, she is noted to have a dense consolidation as well as bilateral interlobular septal thickening and centrilobular ground-glass. On the CT scan, her cardiac chambers appear normal in size save for a massively dilated left atrium and enlarged pulmonary veins. An influenza swab is positive and she is evaluated by both CT surgery and the medical ICU fellow.
Atrial Fibrillation for the Intensivist – part 1
Atrial Fibrillation for the Intensivist …
Atrial Fibrillation for the Intensivist – part 1
Jon-Emile S. Kenny MD [@heart_lung] with illustrations by Carla M Canepa MD [@_carlemd_] “The habit of writing for my eye is good practice. It loosens the ligaments.” ― Virginia Woolf Case A 28 year old woman with known severe mitral stenosis from rheumatic heart disease presents with acute onset shortness of breath. Her acute dyspnea began while walking out of the airport following a 12-hour flight. She is taking oral contraceptive pills and notes pleuritic chest pain in the emergency department, she also endorses one week of chills with a non-productive cough. Her heart rate is 145 beats per minute and irregular with a blood pressure of 102/88, an oxygen saturation of 90% and a low-grade fever. An ECG reveals atrial fibrillation and a CT angiogram is performed to evaluate for pulmonary embolus. A peripheral wedge-shaped opacity is noted distal to a small, sub-segmental pulmonary embolus. In the contralateral lung, she is noted to have a dense consolidation as well as bilateral interlobular septal thickening and centrilobular ground-glass. On the CT scan, her cardiac chambers appear normal in size save for a massively dilated left atrium and enlarged pulmonary veins. An influenza swab is positive and she is evaluated by both CT surgery and the medical ICU fellow.