![]() ![]() What is the differential diagnosis at this stage? They are also a marker of increased all-cause mortality. Monomorphic ventricular ectopic beats signify a specific abnormal focus of electrical activity in the myocardium and are a risk factor for ventricular tachycardia and ventricular fibrillation. The number of ectopic beats that Shayla has may result in shortness of breath, chest discomfort and feeling faint and nonspecifically unwell. 2,3 Older patients and those with underlying cardiac disease, in particular, are at risk of these complications. 3 Ventricular ectopics that number more than 15,000 in 24 hours on Holter monitoring in patients without underlying heart disease can cause such frequent and irregular contractions of the ventricle that ventricular dysfunction or dilated cardiomyopathy may develop. Studies suggest that up to 100 ventricular ectopic beats in a 24-hour period on Holter monitoring are within normal limits. ![]() Shayla needs urgent cardiac echocardiography. What is the significance of this report and what should be done next? There is no ventricular tachycardia or atrial fibrillation. Of these, 18,000 are monomorphic ventricular ectopics, mostly in bigeminy and trigeminy. Shayla undergoes 24-hour Holter monitoring, which shows 22,630 ectopic beats over the period. Measurement of serum troponin level could be considered, but this is unlikely to be abnormal now as the possible myocarditis occurred six weeks previously. In view of the possibility of viral myocarditis and the frequent ectopic beats, blood tests to measure C-reactive protein, thyroid stimulating hormone and serum electrolyte levels, iron studies and a full blood count (to exclude anaemia) would also be reasonable. She should also be advised to moderate her intake of caffeine and alcohol and to take a magnesium supplement daily. Shayla should have 24-hour Holter monitoring. The specialist notes an irregularly irregular pulse, rate 80 to 90 beats per minute, blood pressure of 138/90mmHg, a normal apex beat and no raised jugulovenous pressure or peripheral oedema. Her lung function tests are normal, and asthma is excluded. You refer Shayla to a respiratory specialist who fortuitously can see her immediately. However, the shortness of breath continued. The productive cough responded to doxycycline 100mg twice daily for seven days. A chest x-ray a week after the illness began was reported as normal. Shayla’s illness lasted five days, but the productive cough and shortness of breath continued. Normally she is highly active, but she did not have time to exercise. She felt this extreme pressure was partly why she was so unwell. ![]() He had been ill for over a month, and she had been travelling four hours daily several days a week to see him and her family, while continuing to work as much as possible. This was negative for IgM but positive for IgG to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).Ī few days before her illness began, Shayla’s father died. She consulted you by telephone, and you arranged serum antibody testing on day 4. She had no chest discomfort.Ī PCR test for COVID-19 on day 2 of the illness had negative results. Notably, she had significant shortness of breath on any exertion, although it was not present at rest. She had a headache, myalgia, a sore throat and a dry cough that became productive on day five. Six weeks ago, Shayla developed a temperature of 38.0 to 38.5☌ that lasted for five days. She believes she had coronavirus disease 2019 (COVID-19) a year ago and received the second dose of Comirnaty (Pfizer) two months ago. She has no other medical problems and had normal blood test results six months ago. She also takes atorvastatin 40mg daily and aspirin 100mg daily. Shayla takes candesartan 8mg daily as she was diagnosed with hypertension 10 years ago. She presents for a telephone consultation with continuing shortness of breath on exertion since an illness six weeks ago. Shayla, aged 48 years, has been a patient of your practice for many years. ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |