|Click to enlarge|
- What are the key ECG features ?
- How would you mange this patient ?
Thank you, Claire, for presenting a case of a young man who presented with acute abdominal pain found to have appendicitis and DKA from profound hypertriglyceridemia!
Check out this awesome post from Anna Parks also about hypertriglyceridemia and pancreatitis! She reviews the many causes of endogenous and exogenous substances that can cause lab interference, genetic causes of hypertriglyceridemia, and treatment.
More on plasmapheresis for treatment of HTG-AP
In this systemic review of HTG-AP, the authors found 8 studies that evaluated plasmapheresis as a specific treatment for HTG-AP. All 8 studies concluded that plasmapheresis is an effective treatment for reducing serum triglyceride concentration. Two studies found that symptoms of acute pancreatitis, particulary abdominal pain, were also improved. In patients with chronically elevated triglycerides, 2 studies found that long-term, routing plasmapheresis decreased recurrence of HTG-AP. In summary, the authors concluded that the treatment does not seem to decrease the morbidity and mortality of HTG-AP. However, prospective, randomized trials are needed!
This treatment seemed to work magic for Claire’s patient! Here’s a photo of the fat that was apheresed from her patient’s blood.
Thank you Nadia (my co-fellow to be next year!!) for presenting an amazing cardiology case with Anne Thorson. She presented the case of a man w/ hx of crack cocaine use and recent strep pneumo meningitis p/w acute SOB found to have a diastolic murmur, PR prolongation, sinus exit block and an perivalvular abscess!! The patient was found to have severe chronic AI and was being evaluated by CT surgery for definitive management while on IV abx. Keep us updated!!
For more information see – https://lifeinthefastlane.com/ecg-library/sa-exit-block/