inpatient hospice facility closer to her home.
weight loss and constant abdominal pain. As more cases of post RYGB malignancies are reported, further research is needed to clarify the association between gastric bypass and stomach cancer to keep potential bypass patients aware of all potential complications.
Discussion: Although the development of cancer in the remnant stomach after gastric bypass is rare, it is important to consider the possibility particularly in patients with concerning symptoms such as extreme
POSTERIOR PAPILLARY RUPTURE FOLLOWING INFERIOR STEMI Ibrahim Shenawi, Jonathan Vignes; Department of Medicine, LSU Health Sciences Center, Lafayette, LA.
Introduction: It is important to be cognizant of different sequelae that can result from a ST segment elevation myocardial infarction as some of the sequelae can be deadly. We present a case of an inferior STEMI that evolved to papillary muscle rupture and resultant flail mitral valve. Case: A 59-year-old gentleman with a history of kidney stones and hyperlipidemia with reported worsening shortness of breath on exertion. EKG found ST elevations in leads III and AVF with reciprocal ST depressions in leads I, aVL, V5 and V6. Patient was immediately brought in to the cath lab for intervention. Coronary angiogram revealed severe multivessel disease in the LAD, circumflex, and a 100% occlusion in the mid RCA. An LVAD was placed, and patient underwent high risk PCI which restored flow in the RCA. Patient began to improve clinically with his lactate improving from 10.2 to 2.8. However, the following day patient required increasing vasopressor support and positive pressure for increasing hypoxia. There were also suction alarms from the Impella. Patient’s lactate
became incalculable at greater than 12. At that point the patient was transferred to a tertiary facility for VA ECMO via helicopter. An transesophageal echocardiogram showed a flail motion of the P2 segment of the posterior leaflet, with severe mitral regurgitation. The patient was taken by cardiothoracic surgery for emergent intervention, where a ruptured posterior papillary muscle causing severe flail of the posterior leaflet was identified. Mitral valve was replaced with a bioprosthesis, and the patient underwent a coronary artery bypass graft for his LAD lesion. The patient remained in the intensive care unit on VA ECMO, where he was able to be weaned off both ECMO and the ventilator. Discussion: Torn papillary muscle is a rare complication of STEMI’s. The posterior papillary muscle’s blood supply from the RCA is at risk after an inferior ST-elevation myocardial infarction. It is important to be cognizant of not only myocardial infarctions, but to also look for sequelae that can occur days to weeks after an MI.
TUBERCULOUS PERICARDIAL EFFUSION WITH TAMPONADE IN PATIENT WITH NEWLY DIAGNOSED HIV Ashley Van, Ian Denys, Hope Oddo-Moise, Terrance Park, Emilie Bourgeois, Jorge Martinez, Victoria Burke, Lee Engel; Department of Medicine, LSU Health Sciences Center, New Orleans, LA.
Introduction: Mycobacterium tuberculosis (MTB), more commonly reported in developing countries, is the cause of over 85% of pericardial effusions associated with HIV infection. Case: A 32-year-old man from Honduras presented with a two-week history of intermittent fevers, diaphoresis, diarrhea, and myalgia. At presentation, his temperature was 102.5 F, he was tachycardic with a rate of 151 bpm and had a blood pressure of 116/69 mmHg. He was diaphoretic, had distant heart sounds and had oral thrush. Labs were significant
for troponin 13 pg/mL, WBC 8.1K/uL, CRP 15.5 mg/ dL, and ESR 79 mm/hr. His HIV test was positive and his CD4 count was 12 cells/mm3 (4.4). T spot was negative. Chest x-ray showed cardiomegaly. EKG had diffuse ST segment elevations. Echocardiogram revealed large pericardial effusion with tamponade physiology. The patient underwent emergent pericardiocentesis. Pericardial fluid resulted with cell count 100 (96% neutrophils), protein 4.8 g/dL, LDH 1548 U/L, glucose 21 mg/dL, adenosine deaminase 35 U/L and acid fast smear negative. He was not started on therapy and his hospital course was 29
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