SEVERE ABDOMINAL PAIN SECONDARY TO CELIAC ARTERY STENOSIS. Teresa Cao 1 , Sepehr Sadeghi DO 2 , Victoria Lulich MD 2 , Michael Modica MD 2 ; School of Medicine 1 , Department of Medicine 2 , LSU Health New Orleans, New Orleans, LA.
Introduction: Celiac artery stenosis can result from atherosclerosis or compression of the celiac artery by the median arcuate ligament, the latter of which is labeled as celiac artery compression syndrome. Case: A 45-year-old man with Graves Disease, Hypertension, Seizure Disorder, Tobacco use, and Cannabis use presented with complaints of nausea, vomiting, and diffuse abdominal pain that began one day before presentation. He had similar presentations over the past 2 years, which were labeled as cannabis hyperemesis syndrome. He reported sharp, diffuse, paroxysmal abdominal pain precipitated by smoking and eating. These symptoms would occasionally awaken him at night. He reported relief with capsaicin cream distributed over the abdomen and warm showers. Associated symptoms included 8-9 episodes of vomiting that were light green in color and palpitations with occasional chest pain in the last month. On presentation, the patient was tachycardic and hypertensive. Physical examination was significant for a thin body habitus and tenderness to palpation at the mid- epigastric region with guarding and no rebound tenderness. Laboratory data revealed lactate of 0.8, undetectable TSH, and elevated free T4, consistent
with thyrotoxicosis secondary to medication non-adherence. Electrocardiogram showed sinus tachycardia, left atrial enlargement, right bundle branch block, and left ventricular hypertrophy. Vital signs were stabilized after the patient was fluid resuscitated and received propylthiouracil and propranolol. His abdominal symptoms persisted despite treatment with proton pump inhibitors and antiemetics and notably worsened every time he smoked a cigarette. An upright abdominal x-ray showed no evidence of perforation. Computerized tomography angiography (CTA) of the abdomen/ pelvis showed 80-85% stenosis of the celiac artery. The patient decided to leave against medical advice pending vascular surgical evaluation. Discussion: Although rare, celiac artery stenosis should be considered in the differential for recurrent post-prandial epigastric pain in middle- aged men who smoke. Diagnostic modalities include Doppler ultrasound, magnetic resonance imaging, and computerized tomography angiography. An ultrasound would reveal elevated celiac artery peak systolic velocities greater than 200cm/s and a deflection angle greater than 50 degrees with deep expiration.
A CASE OF SYMPTOMATIC TACHYARRHYTHMIA OF UNKNOWN ETIOLOGY Coleen Leslie 1 , Michael Olejniczak MD 2 , Ilija Zecevic MD 2 , Alex Glaser MD 2 ; School of Medicine 1 , Department of Medicine 2 , LSU Health New Orleans, New Orleans, LA
Introduction: Tachyarrhythmias, namely supraventricular tachycardias, is a source of distress and discomfort for many around the world and is frequently a cause for admission. Although sometimes it can be relatively asymptomatic, a subset of patients have significant symptomatology when having this rhythm. Infrequently, it is also a cause of sudden cardiac death; therefore, diagnosis and treatment are imperative. In this report, we detail a case of significant symptomatology and puzzling etiology. Case: A 42-year-old female with essential hypertension, pre-diabetes, and polycystic ovarian syndrome presented with new onset chest pain upon exertion. The first episode of symptoms
occurred while the patient was performing her regular duties as a housekeeping manager when she suddenly experienced palpitations and diaphoresis relieved with rest. One week later, the patient experienced her second episode of palpitations, and shoulder and jaw pain while grocery shopping. A stress electrocardiogram (EKG) was prematurely aborted due to similar pain in her left shoulder and jaw, along with dizziness, lightheadedness, and palpitations with a run of pleomorphic non-sustained ventricular tachycardia captured on EKG. The patient was admitted by the cardiology team for further evaluation. The EKG recorded during the stress test exhibited nonsustained ventricular tachycardia, a heart rate of 280 beats per minute, and variable morphology closely coupled to a T wave with a
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