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Transiently elevated estimated pulmonary pressures in a patient with complete heart block undergoing permanent pacing: a case report.
Eur Heart J Case Rep. 2020 Jun; 4(3):1-4.EH

Abstract

Background

Complete heart block (CHB) is a frequent cause for acute admission in older patients with significant cardiac conduction disease. Common presenting symptoms are syncope and dyspnoea. Some patients may exhibit clinical and radiological signs of left ventricular (LV) decompensation, despite preserved LV ejection fraction on transthoracic echocardiography (TTE) and absent pre-existing LV dysfunction.

Case summary

In this clinical report, we present a case of CHB associated with transient but severe elevation in pulmonary artery systolic pressure, measured as the equivalent right ventricular systolic pressure (RVSP = 99 mmHg) by TTE in the absence of right ventricular outflow tract obstruction, that subsequently 'normalized' after implantation of a permanent pacemaker. After searching our echocardiogram database, we did find other cases with similar findings.

Discussion

There is limited literature describing transient acute elevation in estimated pulmonary pressures in the setting of new CHB that is subsequently reversed by permanent pacing. The true prevalence and mechanism of transient estimated pulmonary pressure as a result of CHB remains unknown. Based on our limited assessment, we postulate that the acute elevation in estimated pulmonary pressures is predominantly related to a compensatory augmentation of RV stroke volume and is caused by the underlying bradycardia and need to maintain forward cardiac output. This phenomenon may require further investigation and validation in future studies.

Authors+Show Affiliations

Cardiology Department, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Brisbane, Queensland 4102, Australia.Cardiology Department, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Brisbane, Queensland 4102, Australia.Cardiology Department, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Brisbane, Queensland 4102, Australia.Cardiology Department, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Brisbane, Queensland 4102, Australia.

Pub Type(s)

Case Reports

Language

eng

PubMed ID

32617473

Citation

Harvey, Robert, et al. "Transiently Elevated Estimated Pulmonary Pressures in a Patient With Complete Heart Block Undergoing Permanent Pacing: a Case Report." European Heart Journal. Case Reports, vol. 4, no. 3, 2020, pp. 1-4.
Harvey R, Chong A, Hill J, et al. Transiently elevated estimated pulmonary pressures in a patient with complete heart block undergoing permanent pacing: a case report. Eur Heart J Case Rep. 2020;4(3):1-4.
Harvey, R., Chong, A., Hill, J., & Korczyk, D. (2020). Transiently elevated estimated pulmonary pressures in a patient with complete heart block undergoing permanent pacing: a case report. European Heart Journal. Case Reports, 4(3), 1-4. https://doi.org/10.1093/ehjcr/ytaa072
Harvey R, et al. Transiently Elevated Estimated Pulmonary Pressures in a Patient With Complete Heart Block Undergoing Permanent Pacing: a Case Report. Eur Heart J Case Rep. 2020;4(3):1-4. PubMed PMID: 32617473.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Transiently elevated estimated pulmonary pressures in a patient with complete heart block undergoing permanent pacing: a case report. AU - Harvey,Robert, AU - Chong,Adrian, AU - Hill,John, AU - Korczyk,Dariusz, Y1 - 2020/05/26/ PY - 2019/10/31/received PY - 2019/12/04/revised PY - 2020/03/12/accepted PY - 2020/7/4/entrez PY - 2020/7/4/pubmed PY - 2020/7/4/medline KW - Case report KW - Complete heart block KW - Echocardiogram KW - Permanent pacemaker KW - Pulmonary hypertension KW - RVSP KW - Stroke volume SP - 1 EP - 4 JF - European heart journal. Case reports JO - Eur Heart J Case Rep VL - 4 IS - 3 N2 - Background: Complete heart block (CHB) is a frequent cause for acute admission in older patients with significant cardiac conduction disease. Common presenting symptoms are syncope and dyspnoea. Some patients may exhibit clinical and radiological signs of left ventricular (LV) decompensation, despite preserved LV ejection fraction on transthoracic echocardiography (TTE) and absent pre-existing LV dysfunction. Case summary: In this clinical report, we present a case of CHB associated with transient but severe elevation in pulmonary artery systolic pressure, measured as the equivalent right ventricular systolic pressure (RVSP = 99 mmHg) by TTE in the absence of right ventricular outflow tract obstruction, that subsequently 'normalized' after implantation of a permanent pacemaker. After searching our echocardiogram database, we did find other cases with similar findings. Discussion: There is limited literature describing transient acute elevation in estimated pulmonary pressures in the setting of new CHB that is subsequently reversed by permanent pacing. The true prevalence and mechanism of transient estimated pulmonary pressure as a result of CHB remains unknown. Based on our limited assessment, we postulate that the acute elevation in estimated pulmonary pressures is predominantly related to a compensatory augmentation of RV stroke volume and is caused by the underlying bradycardia and need to maintain forward cardiac output. This phenomenon may require further investigation and validation in future studies. SN - 2514-2119 UR - https://www.unboundmedicine.com/medline/citation/32617473/Transiently_elevated_estimated_pulmonary_pressures_in_a_patient_with_complete_heart_block_undergoing_permanent_pacing:_a_case_report DB - PRIME DP - Unbound Medicine ER -
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