SHM Converge Scientific Abstract ePoster Gallery-Nstemi in Scleroderma Renal Crisis: To Cath or Not to Cath

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This case describes a 52-year-old woman with scleroderma and antiphospholipid syndrome who came to the emergency department with chest pain. Initial workup showed elevated troponin levels, sinus tachycardia without ischemic EKG changes, acute kidney injury, bilateral pleural effusions, and new severe left ventricular dysfunction on echocardiogram with an ejection fraction of 20% (previously 60%). She was admitted with concern for NSTEMI and new heart failure.<br /><br />Because her renal function worsened, cardiac catheterization was deferred. She was started on captopril, given concern for scleroderma renal crisis, a serious complication that can cause malignant hypertension and acute renal failure. A cardiac MRI was then performed to evaluate for a non-obstructive cause of her cardiac findings. The MRI showed concentric thickening of the left ventricular myocardium and features consistent with non-ischemic cardiomyopathy, making obstructive coronary disease less likely and reducing the need for catheterization at that time.<br /><br />Despite treatment, her renal failure continued to worsen and she developed encephalopathy, ultimately requiring hemodialysis.<br /><br />The main teaching point is that in patients with scleroderma, chest pain and elevated troponins may reflect demand ischemia or non-ischemic cardiac involvement rather than true obstructive coronary disease. This case highlights the importance of thorough evaluation of the presenting complaint and the value of non-invasive imaging, such as cardiac MRI, in guiding diagnosis and management while avoiding unnecessary invasive procedures when appropriate.

Asset Subtitle

Stormy Keppel

Meta Tag

Author List Stormy Keppel

Category Clinical Vignettes

Concept Diffuse Systemic Sclerosis

Concept Scleroderma Renal Crisis

Concept Cardiac Involvement

Concept Ischemic Cardiomyopathy

Concept Nonischemic Cardiomyopathy

Distinguished Non-Finalist

Presenter Organization Northwell Health

Presenting Author Stormy Keppel

Track Adult

Keywords

scleroderma

antiphospholipid syndrome

chest pain

elevated troponin

acute kidney injury

scleroderma renal crisis

heart failure

left ventricular dysfunction

cardiac MRI

non-ischemic cardiomyopathy

Diffuse Systemic Sclerosis

Scleroderma Renal Crisis

Cardiac Involvement

Ischemic Cardiomyopathy

Nonischemic Cardiomyopathy