Pectus excavatum: A cause of serious cardiac dysfunction and dysrhythmia

Terry Li, Evan Bishop-Rimmer, Mason Shieh, Paul Kreiger, Marc Felberbaum, Michael Heller

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

A 24-year-oldwoman presented to the emergency department (ED) with new onset of palpitations. The patient was found to have pectus excavatum on examination and atrial fibrillation with rapid ventricular response and a right bundle branch block on electrocardiogram; she underwent synchronized cardioversion, which restored normal sinus rhythm. All laboratories were negative. Transthoracic echocardiogram and cardiac magnetic resonance imaging revealed that the sternum was compressing the right ventricular wall causing a decreased right ventricular ejection fraction. Right atrial enlargement and pulmonary hypertension were also noted. Based on a markedly abnormal thoracic width-to-depth ratio (the Haller index), the patient was referred for operative repair and genetic testing for connective tissue disease was recommended. Pectus excavatum is a common occurrence in emergency practice, occurring in approximately 1 in 300 individuals. Although it is generally dismissed as a benign condition, our case demonstrates that it may cause significant and even life-threatening cardiac complications. Direct compression of the right ventricular free wall by the chest wall in this case led to tricuspid regurgitation with right atrial enlargement, causing the atrial fibrillation, which prompted the ED visit. This is but one of the many complications that can arise from pectus excavatum. Emergency clinicians should be aware of the spectrum of cardiac physiologic and conduction abnormalities that this often overlooked condition may cause.

Original languageEnglish
Pages (from-to)1333.e1-1333.e2
JournalAmerican Journal of Emergency Medicine
Volume33
Issue number9
DOIs
StatePublished - 1 Sep 2015
Externally publishedYes

Fingerprint

Dive into the research topics of 'Pectus excavatum: A cause of serious cardiac dysfunction and dysrhythmia'. Together they form a unique fingerprint.

Cite this