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Bottom-up cardiac impact of a pubic ramus fracture

Bottom-up cardiac impact of a pubic ramus fracture 3500 Cardiovascular flashlight doi:10.1093/eurheartj/ehz674 CARDIOVASCULAR FLASHLIGHT Online publish-ahead-of-print 4 October 2019 .................................................................................................................................................... Jonas Dominik Haner € and Jonas Lanz * Department of Cardiology, Bern University Hospital, University of Bern, 3010 Bern, Switzerland * Corresponding author. Tel: (141 31) 632 50 00, Fax: (141 31) 632 42 99, Email: jonas.lanz@insel.ch A 78-year-old female patient was hospital- ized for conservative treatment of a trau- matic pubic ramus fracture. Five days later, she developed epigastric pain and vomitus. The electrocardiogram (ECG) was sugges- tive of inferior–posterior ST-elevation myocardial infarction (Panel A). Emergency coronary angiography, however, revealed normal coronary arteries. Left ventricular angiography showed hyperdynamic sys- tolic left ventricular function and severe mitral regurgitation. During expiration, a drop in systolic aortic pressure of 50 mmHg was noted (Panel B). Due to a supra-diaphragmal tumour visible on fluo- roscopy, computed tomography was ordered, which revealed perforation of the ileum by a pubic bone fragment causing mechanical ileus with massive distention of hiatal hernia and compression of the left heart chambers (Panel C). After insertion of a nasogastric tube, ECG normalized and mitral regurgitation disappeared. The patient underwent laparoscopic surgery with ileostomy and was discharged 14 days later. Extrapericardiac masses may cause ischaemia-like ECG changes by left ventricular compression. The drop in systolic blood pressure during expiration can be explained by the cranial shift of the hiatal hernia increasing compression of the left atrium and distortion of the mitral valve complex with dynamic mitral regurgitation and resulting in less antegrade ejection of the left ventricle. V C Published on behalf of the European Society of Cardiology. All rights reserved. The Author(s) 2019. For permissions, please email: journals.permissions@oup.com. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png European Heart Journal Oxford University Press

Bottom-up cardiac impact of a pubic ramus fracture

Häner, Jonas Dominik; Lanz, Jonas
European Heart Journal , Volume 40 (42): 1 – Oct 4, 2019
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Publisher
Oxford University Press
Copyright
Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019. For permissions, please email: journals.permissions@oup.com.
ISSN
0195-668X
eISSN
1522-9645
DOI
10.1093/eurheartj/ehz674
Publisher site
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Abstract

3500 Cardiovascular flashlight doi:10.1093/eurheartj/ehz674 CARDIOVASCULAR FLASHLIGHT Online publish-ahead-of-print 4 October 2019 .................................................................................................................................................... Jonas Dominik Haner € and Jonas Lanz * Department of Cardiology, Bern University Hospital, University of Bern, 3010 Bern, Switzerland * Corresponding author. Tel: (141 31) 632 50 00, Fax: (141 31) 632 42 99, Email: jonas.lanz@insel.ch A 78-year-old female patient was hospital- ized for conservative treatment of a trau- matic pubic ramus fracture. Five days later, she developed epigastric pain and vomitus. The electrocardiogram (ECG) was sugges- tive of inferior–posterior ST-elevation myocardial infarction (Panel A). Emergency coronary angiography, however, revealed normal coronary arteries. Left ventricular angiography showed hyperdynamic sys- tolic left ventricular function and severe mitral regurgitation. During expiration, a drop in systolic aortic pressure of 50 mmHg was noted (Panel B). Due to a supra-diaphragmal tumour visible on fluo- roscopy, computed tomography was ordered, which revealed perforation of the ileum by a pubic bone fragment causing mechanical ileus with massive distention of hiatal hernia and compression of the left heart chambers (Panel C). After insertion of a nasogastric tube, ECG normalized and mitral regurgitation disappeared. The patient underwent laparoscopic surgery with ileostomy and was discharged 14 days later. Extrapericardiac masses may cause ischaemia-like ECG changes by left ventricular compression. The drop in systolic blood pressure during expiration can be explained by the cranial shift of the hiatal hernia increasing compression of the left atrium and distortion of the mitral valve complex with dynamic mitral regurgitation and resulting in less antegrade ejection of the left ventricle. V C Published on behalf of the European Society of Cardiology. All rights reserved. The Author(s) 2019. For permissions, please email: journals.permissions@oup.com.

Journal

European Heart Journal – Oxford University Press

Published: Oct 4, 2019

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