Broken Hearts (Echo blog series- Case 3)
Updated: Jul 4
Case 3: Broken Lungs + Broken Heart
A year or two after our center opened, a young male patient presented with chronic cough, generalized fatigue, and unintentional weight loss. His cough was productive of sputum, which was occasionally tinged with blood. His weight was a paltry 64lbs.
Point of care ultrasound of his heart revealed evidence of right heart strain. On apical four chamber view, his right ventricle was roughly equal in size, or perhaps larger, than his left ventricle (not normal... as the right ventricle is typically approximately 2/3 the size of the left ventricle). His interventricular septum exhibited septal bounce (a paradoxical bouncing motion of the interventricular septum).
On parasternal short axis view, septal bounce could also be noted as well as a characteristic "D sign." The "D sign" on echo occurs when the left ventricle takes on a D shaped configuration due to right heart overload of pressure and/or volume. In our patient's case, the right heart strain noted on echo was most likely due to chronic lung disease and pulmonary hypertension. His diseased lungs were adversely affecting his cardiac function.
Broken lungs, broken heart.
Additional questioning revealed that the patient had experienced similar symptoms a few years prior and had been treated for PULMONARY TUBERCULOSIS. We encouraged him to be re-evaluated at the TB hospital where he had been treated previously (as diagnosis and treatment of tuberculosis is managed by the ministry of health). He was re-evaluated at the government run TB hospital and medications to treat tuberculosis were initiated.
Unfortunately, he did not improve. The reason for his lack of improvement remains uncertain, but perhaps he had MDR-TB (multidrug resistant TB). We did see him in follow-up on a couple of occasions. At his last visit, he was critically ill- hypoxic, hypotensive, tachycardic, tachypneic. He was depressed and tired. He kept his face covered with a small towel... an action that struck me as remarkably similar to a burial shroud. He died relatively soon thereafter. He died just shy of his 23rd birthday. He died of what some have dubbed "the archetypal disease of poverty." Thus, one could argue that he died of being poor.
BROKEN LUNGS. BROKEN HEART. BROKEN WORLD.