Cardiac Amyloidosis

Noon Report from a few weeks ago!

We discussed the case of a middle aged man with history of LTBI who presented with chronic episodic dizziness associated with syncope, chronic unintentional weight loss and fatigue, found to have a new systolic murmur on exam, with EKG showing bradycardia, low voltages, while the echocardiogram showed new diastolic dysfunction, and significant septal thickening. The discordance between echocardiogram showing LV hypertrophy without evidence of increased voltages on EKG increased suspicion for infiltrative process within the heart, leading to a diagnosis of cardiac amyloidosis.

High output Heart Failure

Today we discussed a case of a young woman with Lupus, Lupus Nephritis leading ESRD with recent transition from HD via AV Fistula to Peritoneal Dialysis, who presented with peritonitis with course complicated by afib RVR s/p dilt/metop w/ associated hypotension/bradycardia concerning for cardiogenic sock, found to have with new RV dilation, severe TR, and new HF. She was diagnosed with high output heart failure, AV access was ligated, with reversal of HF and TR!

Myxedema coma

Today we discussed the case of a young woman with history of hypothyroidism who was unhoused and not taking medications for 2 months, presenting with subacute onset fatigue, with periorbital and bilateral lower extremity edema and lower extremity hyperpigmentation, found to have profound hypothyroidism vs mild myxedema coma.

We also discussed a MKSAP question on management of intracranial hemorrhage, as review of American Heart Association’s guidelines for management of hypertensive emergency.