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Ventricular Tachycardia and the Cystic Heart: A Case Report
Sweta Giri1, Shankar LeVine1, Melanie R Watts1
1Department of Emergency Medicine, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan.
Insights
Point-of-care ultrasound (POCUS) aided in diagnosing a rare cardiac hydatid cyst in Bhutan. Early POCUS detection is crucial for managing this re-emerging zoonotic disease, especially in resource-limited settings.
Area of Science:
- Parasitology
- Infectious Diseases
- Cardiology
Background:
- Hydatidosis, caused by Echinococcus granulosus, is a re-emerging zoonotic disease globally.
- While hepatic hydatid cysts are common, cardiac involvement is rare.
- Serologic tests for hydatidosis have low sensitivity and specificity, necessitating advanced imaging.
Observation:
- A 79-year-old woman presented with shortness of breath and ventricular tachycardia.
- Point-of-care ultrasound (POCUS) detected a cardiac hydatid cyst, confirmed by CT scan.
- This represents the first reported case of cardiac hydatid cyst in Bhutan.
Findings:
- POCUS is vital for diagnosing cardiac hydatid cysts, especially in resource-limited areas.
- Cardiac hydatid cysts should be considered in the differential diagnosis of structural causes of arrhythmias.
- Accurate diagnosis is critical as treatment for unstable arrhythmias must be modified to prevent fatal cyst rupture and anaphylaxis.
Implications:
- Highlights the diagnostic utility of POCUS in emergency medicine for rare conditions.
- Emphasizes the need to include cardiac hydatid cysts in the differential diagnosis of cardiac emergencies.
- Underscores the importance of recognizing and managing hydatidosis as a re-emerging global health threat.
Background:
Hydatid cysts are caused by Echinococcus granulosus infection, and hydatidosis is recognized as a re-emerging zoonotic disease globally. While the liver is the most commonly affected organ, other organs can also be affected, including the heart. Because of the low sensitivity and specificity of serologic diagnostic tests, ultrasound and echocardiography are increasingly used to make the diagnosis of cardiac hydatid cyst.
Case Report:
We report the case of a cardiac hydatid cyst, detected by point-of-care ultrasound (POCUS), in a 79-year-old woman who presented with shortness of breath and was in ventricular tachycardia. The diagnosis was further confirmed with a computed tomography scan. Although cases of alveolar and liver hydatid cysts are seen, this is the first case of a cardiac hydatid cyst in Bhutan. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case illustrates the importance of POCUS in reaching a diagnosis, particularly in resource-poor areas where other sophisticated diagnostic tools are not easily available. A cardiac hydatid cyst must be in the differential for structural causes of dysrhythmias. This is especially so because treatment of unstable dysrhythmias in the acute setting of an emergency department has to be modified from the usual algorithm in the presence of a cardiac hydatid cyst, due to the potentially fatal risk of cyst rupture and anaphylaxis.
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