Further Consideration in Evaluation of Right Ventricular Infarction Lovely Chhabra MD, Vinod K. Chaubey MD PII: DOI: Reference:
S0735-6757(15)00127-8 doi: 10.1016/j.ajem.2015.02.038 YAJEM 54826
To appear in:
American Journal of Emergency Medicine
Received date: Accepted date:
2 February 2015 21 February 2015
Please cite this article as: Chhabra Lovely, Chaubey Vinod K., Further Consideration in Evaluation of Right Ventricular Infarction, American Journal of Emergency Medicine (2015), doi: 10.1016/j.ajem.2015.02.038
This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT Further Consideration in Evaluation of Right Ventricular Infarction
T
Lovely Chhabra1, MD, Vinod K Chaubey2, MD.
RI P
Dept. of Cardiovascular Medicine1, Hartford Hospital1, University of Connecticut School of Medicine1, Hartford, CT
SC
Dept. of Medicine2, Saint Vincent Hospital2, University of Massachusetts Medical
PT
ED
MA NU
School2, Worcester, MA
Correspondence Address:
CE
Vinod K Chaubey MD
123 Summer Street, Worcester, MA 01604.
AC
Tel: +1 508-363-5000
Fax: +1 508-363-9798 Email – [email protected]
Funding: None Word Count: 277
ACCEPTED MANUSCRIPT Dear Editor,
T
We read with great pleasure the interesting report by Aiman et al.1 The proposed
RI P
hypothesis of vasospasm of isolated right sided coronary arteries is appealing and well possible however other relevant considerations should be entertained especially
SC
in the absence of objective evidence of vasospasm during coronary angiography. Since the patient was unresponsive, hypotensive and acidotic, concomitant
MA NU
significant hypoxia is presumably highly likely. Patients with hypoxic respiratory failure or even drug overdose can manifest as transient right ventricular dysfunction and also frequently with biventricular dysfunction.2 Again, elevated pulmonary artery
ED
pressures and pulmonary vascular resistance may be explained in this setting by associated hypoxia related pulmonary vasoconstriction and mild left ventricular
PT
dysfunction resulting in the elevation of wedge pressures.
CE
In addition, it would be prudent to exclude yet another differential diagnosis viz. atypical right ventricular variant Tako-Tsubo cardiomyopathy resulting from cocaine
AC
use.3,4 From the provided data alone, the exclusion of TC is not possible. An echocardiographic video illustration would be valuable for the readers. Furthermore, the information on right ventricular peak systolic longitudinal strain and tricuspid annular plane systolic excursion (TAPSE) would be important as they are invaluable tools for the assessment of right ventricular function.5-7 If indeed, the patient had lower TAPSE values along with reduced early diastolic mitral annular velocities (E') on initial arrival with interval improvement on the tissue Doppler imaging, it may still suggest transient biventricular dysfunction (even in the presence of visually estimated normal systolic left ventricular function at the time of recording) supporting our hypothesis. Moreover, in patients with TC with biventricular involvement, right
ACCEPTED MANUSCRIPT ventricular function recovery may often lag behind and prolong the recovery and hospitalization5-6.
AC
CE
PT
ED
MA NU
SC
RI P
T
We would appreciate the authors’ response.
ACCEPTED MANUSCRIPT References
RI P
T
1. Smer Aiman, Haddad Toufik Mahfood, Narayanan Mahesh Anantha, Devineni Harish, Alla Venkata, A Rare Case of Cocaine Induced Isolated Right Ventricular Infarction, American Journal of Emergency Medicine (2014), doi: 10.1016/j.ajem.2014.12.053.
SC
2. Liu SS1, Kovell LC, Horne A Jr, Chang D, Petronis JD, Zakaria S. A novel case of transient right ventricular failure in a patient with respiratory distress. J Intensive Care Med. 2013;28(3):185-8.
MA NU
3. Sarkar S, Arguelles E, de Elia C. Takosubo cardiomyopathy presenting as a non-ST segment elevation myocardial infarction in the setting of cocaine use and asthma exacerbation. Int J Cardiol. 2013;168(1):e1-2. 4. Kagiyama N, Okura H, Kume T, Hayashida A, Yoshida K. Isolated right ventricular takotsubo cardiomyopathy. Eur Heart J Cardiovasc Imaging. 2014 Oct 28. pii: jeu207.
ED
5. Heggemann F, Hamm K, Brade J, Streitner F, Doesch C, Papavassiliu T, Borggrefe M, Haghi D. Right ventricular function quantification in takotsubo cardiomyopathy using two-dimensional strain echocardiography. PLoS One. 2014;9(8):e103717.
CE
PT
6. Chaubey VK, Chhabra L, Kaur NJ. Evaluation of right ventricular function in Takotsubo cardiomyopathy. Am J Emerg Med. 2015 Jan 6. pii: S07356757(14)00985-1. doi: 10.1016/j.ajem.2014.12.064.
AC
7. Chhabra L, Khalid N, Kluger J, Spodick DH. Lupus myopericarditis as a preceding stressor for takotsubo cardiomyopathy. Proc (Bayl Univ Med Cent). 2014;27(4):32730.
S0735-6757(15)00127-8 doi: 10.1016/j.ajem.2015.02.038 YAJEM 54826
To appear in:
American Journal of Emergency Medicine
Received date: Accepted date:
2 February 2015 21 February 2015
Please cite this article as: Chhabra Lovely, Chaubey Vinod K., Further Consideration in Evaluation of Right Ventricular Infarction, American Journal of Emergency Medicine (2015), doi: 10.1016/j.ajem.2015.02.038
This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT Further Consideration in Evaluation of Right Ventricular Infarction
T
Lovely Chhabra1, MD, Vinod K Chaubey2, MD.
RI P
Dept. of Cardiovascular Medicine1, Hartford Hospital1, University of Connecticut School of Medicine1, Hartford, CT
SC
Dept. of Medicine2, Saint Vincent Hospital2, University of Massachusetts Medical
PT
ED
MA NU
School2, Worcester, MA
Correspondence Address:
CE
Vinod K Chaubey MD
123 Summer Street, Worcester, MA 01604.
AC
Tel: +1 508-363-5000
Fax: +1 508-363-9798 Email – [email protected]
Funding: None Word Count: 277
ACCEPTED MANUSCRIPT Dear Editor,
T
We read with great pleasure the interesting report by Aiman et al.1 The proposed
RI P
hypothesis of vasospasm of isolated right sided coronary arteries is appealing and well possible however other relevant considerations should be entertained especially
SC
in the absence of objective evidence of vasospasm during coronary angiography. Since the patient was unresponsive, hypotensive and acidotic, concomitant
MA NU
significant hypoxia is presumably highly likely. Patients with hypoxic respiratory failure or even drug overdose can manifest as transient right ventricular dysfunction and also frequently with biventricular dysfunction.2 Again, elevated pulmonary artery
ED
pressures and pulmonary vascular resistance may be explained in this setting by associated hypoxia related pulmonary vasoconstriction and mild left ventricular
PT
dysfunction resulting in the elevation of wedge pressures.
CE
In addition, it would be prudent to exclude yet another differential diagnosis viz. atypical right ventricular variant Tako-Tsubo cardiomyopathy resulting from cocaine
AC
use.3,4 From the provided data alone, the exclusion of TC is not possible. An echocardiographic video illustration would be valuable for the readers. Furthermore, the information on right ventricular peak systolic longitudinal strain and tricuspid annular plane systolic excursion (TAPSE) would be important as they are invaluable tools for the assessment of right ventricular function.5-7 If indeed, the patient had lower TAPSE values along with reduced early diastolic mitral annular velocities (E') on initial arrival with interval improvement on the tissue Doppler imaging, it may still suggest transient biventricular dysfunction (even in the presence of visually estimated normal systolic left ventricular function at the time of recording) supporting our hypothesis. Moreover, in patients with TC with biventricular involvement, right
ACCEPTED MANUSCRIPT ventricular function recovery may often lag behind and prolong the recovery and hospitalization5-6.
AC
CE
PT
ED
MA NU
SC
RI P
T
We would appreciate the authors’ response.
ACCEPTED MANUSCRIPT References
RI P
T
1. Smer Aiman, Haddad Toufik Mahfood, Narayanan Mahesh Anantha, Devineni Harish, Alla Venkata, A Rare Case of Cocaine Induced Isolated Right Ventricular Infarction, American Journal of Emergency Medicine (2014), doi: 10.1016/j.ajem.2014.12.053.
SC
2. Liu SS1, Kovell LC, Horne A Jr, Chang D, Petronis JD, Zakaria S. A novel case of transient right ventricular failure in a patient with respiratory distress. J Intensive Care Med. 2013;28(3):185-8.
MA NU
3. Sarkar S, Arguelles E, de Elia C. Takosubo cardiomyopathy presenting as a non-ST segment elevation myocardial infarction in the setting of cocaine use and asthma exacerbation. Int J Cardiol. 2013;168(1):e1-2. 4. Kagiyama N, Okura H, Kume T, Hayashida A, Yoshida K. Isolated right ventricular takotsubo cardiomyopathy. Eur Heart J Cardiovasc Imaging. 2014 Oct 28. pii: jeu207.
ED
5. Heggemann F, Hamm K, Brade J, Streitner F, Doesch C, Papavassiliu T, Borggrefe M, Haghi D. Right ventricular function quantification in takotsubo cardiomyopathy using two-dimensional strain echocardiography. PLoS One. 2014;9(8):e103717.
CE
PT
6. Chaubey VK, Chhabra L, Kaur NJ. Evaluation of right ventricular function in Takotsubo cardiomyopathy. Am J Emerg Med. 2015 Jan 6. pii: S07356757(14)00985-1. doi: 10.1016/j.ajem.2014.12.064.
AC
7. Chhabra L, Khalid N, Kluger J, Spodick DH. Lupus myopericarditis as a preceding stressor for takotsubo cardiomyopathy. Proc (Bayl Univ Med Cent). 2014;27(4):32730.
