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Dual chamber pacing in a patient of hypertrophic cardiomyopathy with failure to wean from mechanical ventilator.

Kanjwal S, Kanjwal K, Imran N, Kanjwal Y - Indian Pacing Electrophysiol J (2008)

Bottom Line: She was found to have hypertrophic cardiomyopathy with a gradient of 82 mmHg across the left ventricular outflow tract.Initially adequate rate control and treatment with negative inotropes did not help her condition.Finally a dual chamber pacemaker implantation and atrioventricular node modification lead to successful extubation.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiovascular Medicine University of Toledo Medical Center 3000Arlington Ave Toledo, OH 43614 USA.

ABSTRACT
We discuss the case of a 63 years old female who required repeated intubation due to recurrent pulmonary edema. She was found to have hypertrophic cardiomyopathy with a gradient of 82 mmHg across the left ventricular outflow tract. Initially adequate rate control and treatment with negative inotropes did not help her condition. Finally a dual chamber pacemaker implantation and atrioventricular node modification lead to successful extubation.

No MeSH data available.


Related in: MedlinePlus

Continuous wave (CW) Doppler image across left ventricular outflow tract during pacing showing a decrease in gradient to 8.2 mmHg ( a decrease of 74 mmHg).
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Figure 2: Continuous wave (CW) Doppler image across left ventricular outflow tract during pacing showing a decrease in gradient to 8.2 mmHg ( a decrease of 74 mmHg).

Mentions: 63-year-old Caucasian female, with past medical history of failure of transplanted kidney, persistent atrial fibrillation, hypertension and hypothyroidism was admitted to the intensive care unit with acute respiratory failure secondary to pulmonary edema. She was intubated and treated with intravenous diuretics. An echocardiogram revealed severe hypertrophic cardiomyopathy with a left ventricular outflow gradient of 82 mm Hg (Figure 1). She went through a protracted course of critical illness and multiple trials of extubation had failed. No other cause like electrolyte disturbance, sepsis or any other metabolic cause could be determined. She received multiple medications for rate control in addition to negative ionotrope like disopyramide. Multiple cardio versions were attempted without any success. Patient continued to need reintubation despite adequate rate control and at that time a decision was made to perform atrioventricular node ablation and a pacemaker implant. The outflow gradient decreased dramatically following the procedure from 82 mmHg to 8 mmHg within next few days and patient showed significant improvement and was successfully extubated and transferred out of the intensive care unit (Figure 2).


Dual chamber pacing in a patient of hypertrophic cardiomyopathy with failure to wean from mechanical ventilator.

Kanjwal S, Kanjwal K, Imran N, Kanjwal Y - Indian Pacing Electrophysiol J (2008)

Continuous wave (CW) Doppler image across left ventricular outflow tract during pacing showing a decrease in gradient to 8.2 mmHg ( a decrease of 74 mmHg).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2572023&req=5

Figure 2: Continuous wave (CW) Doppler image across left ventricular outflow tract during pacing showing a decrease in gradient to 8.2 mmHg ( a decrease of 74 mmHg).
Mentions: 63-year-old Caucasian female, with past medical history of failure of transplanted kidney, persistent atrial fibrillation, hypertension and hypothyroidism was admitted to the intensive care unit with acute respiratory failure secondary to pulmonary edema. She was intubated and treated with intravenous diuretics. An echocardiogram revealed severe hypertrophic cardiomyopathy with a left ventricular outflow gradient of 82 mm Hg (Figure 1). She went through a protracted course of critical illness and multiple trials of extubation had failed. No other cause like electrolyte disturbance, sepsis or any other metabolic cause could be determined. She received multiple medications for rate control in addition to negative ionotrope like disopyramide. Multiple cardio versions were attempted without any success. Patient continued to need reintubation despite adequate rate control and at that time a decision was made to perform atrioventricular node ablation and a pacemaker implant. The outflow gradient decreased dramatically following the procedure from 82 mmHg to 8 mmHg within next few days and patient showed significant improvement and was successfully extubated and transferred out of the intensive care unit (Figure 2).

Bottom Line: She was found to have hypertrophic cardiomyopathy with a gradient of 82 mmHg across the left ventricular outflow tract.Initially adequate rate control and treatment with negative inotropes did not help her condition.Finally a dual chamber pacemaker implantation and atrioventricular node modification lead to successful extubation.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiovascular Medicine University of Toledo Medical Center 3000Arlington Ave Toledo, OH 43614 USA.

ABSTRACT
We discuss the case of a 63 years old female who required repeated intubation due to recurrent pulmonary edema. She was found to have hypertrophic cardiomyopathy with a gradient of 82 mmHg across the left ventricular outflow tract. Initially adequate rate control and treatment with negative inotropes did not help her condition. Finally a dual chamber pacemaker implantation and atrioventricular node modification lead to successful extubation.

No MeSH data available.


Related in: MedlinePlus