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• W2894902284 abstract "SESSION TITLE: Cardiovascular Disease 1 SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Systemic corticosteroids are widely used in the management of various inflammatory and immunological conditions. Among the myriad of complications associated with chronic steroid use, some of the well-known ones are osteoporosis, adrenal suppression, hyperglycemia, psychiatric disturbances, dyslipidemia, glaucoma, and cataracts. We present here a case of ventricular septal rupture (VSR) secondary to chronic immunosuppressive therapy with steroids. CASE PRESENTATION: A 64-year-old woman with history of hypertension, hyperlipidemia, diabetes mellitus, and focal segmental glomerulosclerosis, status post right kidney transplant on chronic immunosuppressive therapy with steroids for 10 years, presented with acute, central chest pain radiating to back,associated with nausea, vomiting, and shortness of breath. Initial vitals and physical exam were essentially normal. Initial troponin was 4.32 ng/ml. Electrocardiogram showed sinus rhythm, regular rate, new left bundle branch block and ST elevation in lead V2 and V3. Emergent coronary angiogram showed normal coronaries, ejection fraction (EF) of 45 %, and large apical ventricular septal defect (VSD). Echocardiogram showed EF of 50%, concentric left ventricular hypertrophy, dyskinetic apex, dyskinetic distal 1/3 of anteroseptal wall, and apical VSD measuring 1.4 cm with left-to-right communication with peak pressure gradient of 92 mmHg. Patient later had a cardiac arrest and respiratory failure with return to spontaneous circulation requiring intubation and mechanical ventilation. Patient’s family opted for comfort care and patient eventually died. DISCUSSION: Myocardial ischemia (MI) is seen in 1-2 % of patients with normal coronary arteries. The underlying pathophysiology in those patients could be related to vasospasm, embolism, or hypercoagulability. Glucocorticoids increase the risk of MI not only by impacting the traditional risk factors like hypertension, glucose intolerance, obesity, and hyperlipidemia, but also by influencing vascular functions like vasospasm, atherogenesis, and post ischemic remodeling. Association between chronic steroid use and VSR was first described by Coakley in 1997. Although our patient did not have any significant coronary artery disease (CAD), we hypothesize that she likely had a nonatherosclerotic process like vasospasm leading to acute MI and VSR secondary to chronic steroid use. CONCLUSIONS: Besides traditional complications of chronic steroid use, clinicians should be aware of the cardiovascular complications such as increased risk of atherogenesis, vasospasm, and post ischemic remodeling. And caution should be exercised with chronic steroid use, especially in patients with other known risk factors for CAD. Reference #1: Coakley F, Fennell J, Crean P. Postinfarction ventricular septal defect associated with long term steroid therapy. Irish Med J 1997;90:58. Reference #2: Rogers KM, Bonar CA, Estrella JL, et al. Inhibitory effect of glucocorticoid on coronary artery endothelial function. Am J Physiol Heart Circ Physiol. 2002;283:H1922-8. Reference #3: Okumura W, Nakajima M, Tateno R, et al. Three cases of vasospastic angina that developed following the initiation of corticosteroid therapy. Intern Med. 2014;53:221-5. DISCLOSURES: No relevant relationships by Shashitha Gavini, source=Web Response No relevant relationships by Eric Lee, source=Web Response Speaker/Speaker's Bureau relationship with Novartis Please note: $5001 - $20000 Added 03/02/2018 by Krishna Nagendran, source=Web Response, value=Honoraria No relevant relationships by Naga Sai Shravan Turaga, source=Web Response" @default.
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• W2894902284 date "2018-10-01" @default.
• W2894902284 modified "2023-09-28" @default.
• W2894902284 title "VENTRICULAR SEPTAL RUPTURE: A RARE FATAL COMPLICATION OF CHRONIC STEROID USE" @default.
• W2894902284 doi "https://doi.org/10.1016/j.chest.2018.08.085" @default.
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