Pectus Excavatum-Induced Preload Insufficiency Presenting as Long-Standing Sinus Tachycardia

Severe pectus excavatum is an uncommon cause of hemodynamic compromise in adults and may present with unexplained tachycardia when preload filling is impaired by cardiac compression.

A 65-year-old woman with long-standing palpitations presented with sinus tachycardia despite high-dose beta-blockade. Electrocardiogram and ambulatory monitoring showed sinus rhythm with marked heart rate variability. Right heart catheterization revealed low filling pressures, with a mean right atrial pressure of 1 mm Hg and preserved cardiac output. Cardiovascular magnetic resonance showed severe pectus excavatum (Haller index: 8.1) with anterior cardiac compression. Pectus-induced preload insufficiency was deemed responsible for her symptoms. She underwent a modified Ravitch repair with complete resolution of palpitations and normalization of heart rate.

Chest wall deformity can cause clinically significant cardiac compression, preload insufficiency, and compensatory sinus tachycardia, even in late adulthood.

Severe pectus excavatum should be recognized as a reversible cause of preload insufficiency and sinus tachycardia, and surgical correction may result in symptom resolution.