JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY
ECG CASE OF THE MONTH Life-Long Cyanosis and Dyspnea in an Adult Despite a Cardiac Operation at Age 7 Months
D. Luke Glancy, MD
A 33-year-old man was transferred to the hospital from prison because of dyspnea, chills, headaches, and fever. He apparently was cyanotic at birth, and because of difficulty feeding and failure to thrive had undergone a cardiac operation through amedian sternotomy at the age of 7 months. He had ventricular fibrillation during the procedure, which was then modified. He was somewhat better after the operation, but continued to have exertional dyspnea, and in recent years he has also had orthopnea and paroxysmal nocturnal dyspnea. The patient is married and has 2 children. He has worked as an electrician and as a painter. He has smoked ½ pack of cigarettes per day all of his adult life. When not in prison he has usually consumed 1-2 pints of liquor per week, and he used cocaine until 2-3 years ago. He recently has used oxygen by nasal cannulae for 3-4 hours twice a day. Onexam, his temperaturewas37°C; pulsewas regular at 62beats/minute; bloodpressurewas108/63mmHg; respiratory ratewas14breaths/ min; and O2 saturation by pulse oximeter was 84% on a nonrebreather mask. Neck veins were normal. Chest was clear to auscultation. No precordial pulsation or thrill was palpable. The second heart sound was loud and single, and no murmur was heard. Fingers and toes were equally clubbed and cyanotic. Carotid, radial, and femoral pulses were full, and there was no radial-femoral delay. Posteroarterior chest radiograph showedmild-moderate generalized cardiomegaly. The right atriumwas prominent, and the pulmonary trunk was even more prominent. Pulmonary vascularitywasmore prominent on the left than the right, and the rightmain pulmonary artery looked small. Three blood cultures were sterile. An electrocardiogramwas recorded (Figure 1).
What is your diagnosis? Explication is on p. 177 .
Figure: Electrocardiogram recorded in a cyanotic 33-year-old man without a heart murmur. See text for explication.
176 J La State Med Soc VOL 169 NOVEMBER/DECEMBER 2017
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