An Elderly Woman with Exertional Dyspnoea and T-Wave Inversions on Electrocardiography

Goh, Fang Qin; Sia, Ching‐Hui; Singh, Devinder; Poh, Kian‐Keong; Kong, William Kok-Fai

doi:10.1016/j.cjca.2019.08.019

Cited by 1 publication

(1 citation statement)

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“…In rare cases, they can be symptomatic, as in our case, where the patient complained of intermittent chest pain and shortness of breath on exertion [10]. The most recently debated case in the Canadian Journal of Cardiology presents a case of an elderly female patient who complained of dyspnea on exertion; showed T-wave inversion upon ECG, a coronary angiography negative for ischemia; and was diagnosed with diaphragmatic hernia with cardiac dextroposition [11]. The ECG-specific abnormality in healthy women with T-wave inversion in precordial leads is very suspicious of ischemia, but there are very few cases in the medical literature of these modifications being related to a Morgagni hernia [10,12].…”

Section: Discussionmentioning

confidence: 67%

Acute Respiratory Failure, Ischemic Modifications on Electrocardiogram: Alternative Etiology—A Case of Morgagni Hernia

et al. 2022

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We discovered a rare pathology described in adulthood, followed by the development of a long asymptomatic evolution, which underlined the importance of multidisciplinary collaboration. We present the case of a 62-year-old female smoker patient, with a known previous medical history of chronic ischemic heart disease, hypertension, chronic obstructive pulmonary disease (COPD), gastric ulcer and gastritis. The patient was rushed to the emergency room (ER) with acute respiratory failure, chest discomfort, ankle and facial edema and a chest X-ray showing a right lower pulmonary lobe consolidation, with an alarming ischemic electrocardiogram (ECG) modification without increasing myocardial cytolysis indicators. This led our medical team to investigate a possible cardiovascular event that might have been in development. After immediate admission, thoracic computer tomography (CT) imaging was carried out, which found a Morgagni diaphragmatic hernia, containing adipose tissue and the hepatic flexure of the colon with approximate dimensions of 50/100 mm. We faced differential diagnostic problems. We knew the subject’s existing cardiac and chronic respiratory tract pathologies from their previous medical history; therefore, multiple investigations and check-ups were carried out. A chest CT and surgery intervention were needed to resolve this case. Subsequently, the acute respiratory failure and alarming ischemic ECG modification disappeared.

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