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Dorchester Center, MA 02124

Persistent Left Superior Vena Cava : Cardiac Resynchronization Therapy with Left-Sided Venous Access


Age Gender Occupation Working diagnosis
55 Years Female Housewife Idiopathic Cardiomyopathy

History

This patient had complete heart block, with 30% left ventricular ejection fraction (LVEF) visualized on echocardiography. A temporary pacemaker wire was inserted into the right ventricle via femoral venous access. Coronary artery angiography was performed, ruling out coronary artery disease. The patient was scheduled for a biventricular pacemaker.

Current Medications

The patient was taking carvedilol 6.25 mg twice daily, digoxin (Lanoxin) 0.25 mg daily, furosemide plus spironolactone (Lasilactone) 25 mg twice daily, and enalapril 2.5 mg twice daily.

Current Symptoms

The patient was experiencing symptoms consistent with New York Heart Association (NYHA) class III symptoms.

Physical Examination

  • BP/HR: 110/70 mm Hg/78 bpm

  • Height/weight: 144 cm/62 kg

  • Neck veins: Engorged

  • Lungs/chest: Clear

  • Heart: Prominent third heart sound (S 3 ), no murmer

  • Abdomen: No organomegaly

  • Extremities: Normal

Laboratory Data

  • Hemoglobin: 13.9 g/dL

  • Sodium: 143 mmol/L

  • Potassium: 3.4 mmol/L

  • Creatinine: 73 mmol/L

  • Blood urea nitrogen: 22 mmol/L

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