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Case report
peer-reviewed

Supraventricular Tachycardia and Tricuspid Regurgitation in the Setting of Misplaced Implantable Port Catheter Tip



Abstract

We present the case of a 31-year-old female with a past medical history of B-cell leukemia, on maintenance chemotherapy administered via centrally placed implantable catheter port, who presented to the emergency room with fever, chills, and generalized body pain of one day's duration. After initial workup, the patient was admitted to the intensive care unit and managed for severe sepsis. The patient was found to have a new-onset 3/6 holosystolic murmur at the left lower sternal border. Furthermore, she developed an episode of supraventricular tachycardia that responded to adenosine. Transthoracic echocardiogram revealed severe tricuspid regurgitation but without valvular vegetation. Transesophageal echocardiogram further confirmed the absence of vegetation, in addition to visualizing the tip of the catheter tip in the right atrium and interfering with coaptation of the tricuspid valve. It was postulated that the severe tricuspid regurgitation and supraventricular tachycardia were caused by the catheter tip malposition. The catheter was subsequently removed. The patient’s acute condition resolved and she was referred to cardiothoracic surgery for valvular surgery.



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Case report
peer-reviewed

Supraventricular Tachycardia and Tricuspid Regurgitation in the Setting of Misplaced Implantable Port Catheter Tip


Author Information

Ahmad Awan Corresponding Author

Department of Internal Medicine, Howard University Hospital

Bisma Ahsan

Department of Infectious Disease, Howard University Hospital

Hasan Iftikhar

Department of Internal Medicine, Howard University Hospital

Akbar Khan

Health Information Management, Howard University Hospital

Fasil Tiruneh

Department of Internal Medicine, Howard University Hospital

Yididia Bekele

Patch, Irhythm Technologies Inc

Ankit Mahajan

Cardiology, Howard University Hospital

Ahmed A. Awan

Internal Medicine, Forrest General Hospital, Hattiesburg Ms


Ethics Statement and Conflict of Interest Disclosures

Human subjects: Consent was obtained by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Acknowledgements

The authors would like to thank Dr. Mark Larralde for his help in the interpretation of the echocardiographic images.


Case report
peer-reviewed

Supraventricular Tachycardia and Tricuspid Regurgitation in the Setting of Misplaced Implantable Port Catheter Tip


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Case report
peer-reviewed

Supraventricular Tachycardia and Tricuspid Regurgitation in the Setting of Misplaced Implantable Port Catheter Tip

Ahmad Awan">Ahmad Awan , Bisma Ahsan">Bisma Ahsan, Hasan Iftikhar">Hasan Iftikhar, Akbar Khan">Akbar Khan, Fasil Tiruneh">Fasil Tiruneh, Yididia Bekele">Yididia Bekele, Ankit Mahajan">Ankit Mahajan, Ahmed A. Awan">Ahmed A. Awan

  • Author Information
    Ahmad Awan Corresponding Author

    Department of Internal Medicine, Howard University Hospital

    Bisma Ahsan

    Department of Infectious Disease, Howard University Hospital

    Hasan Iftikhar

    Department of Internal Medicine, Howard University Hospital

    Akbar Khan

    Health Information Management, Howard University Hospital

    Fasil Tiruneh

    Department of Internal Medicine, Howard University Hospital

    Yididia Bekele

    Patch, Irhythm Technologies Inc

    Ankit Mahajan

    Cardiology, Howard University Hospital

    Ahmed A. Awan

    Internal Medicine, Forrest General Hospital, Hattiesburg Ms


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: Consent was obtained by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

    Acknowledgements

    The authors would like to thank Dr. Mark Larralde for his help in the interpretation of the echocardiographic images.


    Article Information

    Published: July 11, 2017

    DOI

    10.7759/cureus.1460

    Cite this article as:

    Awan A, Ahsan B, Iftikhar H, et al. (July 11, 2017) Supraventricular Tachycardia and Tricuspid Regurgitation in the Setting of Misplaced Implantable Port Catheter Tip . Cureus 9(7): e1460. doi:10.7759/cureus.1460

    Publication history

    Received by Cureus: June 18, 2017
    Peer review began: June 27, 2017
    Peer review concluded: July 03, 2017
    Published: July 11, 2017

    Copyright

    © Copyright 2017
    Awan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

We present the case of a 31-year-old female with a past medical history of B-cell leukemia, on maintenance chemotherapy administered via centrally placed implantable catheter port, who presented to the emergency room with fever, chills, and generalized body pain of one day's duration. After initial workup, the patient was admitted to the intensive care unit and managed for severe sepsis. The patient was found to have a new-onset 3/6 holosystolic murmur at the left lower sternal border. Furthermore, she developed an episode of supraventricular tachycardia that responded to adenosine. Transthoracic echocardiogram revealed severe tricuspid regurgitation but without valvular vegetation. Transesophageal echocardiogram further confirmed the absence of vegetation, in addition to visualizing the tip of the catheter tip in the right atrium and interfering with coaptation of the tricuspid valve. It was postulated that the severe tricuspid regurgitation and supraventricular tachycardia were caused by the catheter tip malposition. The catheter was subsequently removed. The patient’s acute condition resolved and she was referred to cardiothoracic surgery for valvular surgery.



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Ahmad Awan

Department of Internal Medicine, Howard University Hospital

For correspondence:
armoghan89@yahoo.com

Bisma Ahsan

Department of Infectious Disease, Howard University Hospital

Hasan Iftikhar

Department of Internal Medicine, Howard University Hospital

Akbar Khan

Health Information Management, Howard University Hospital

Fasil Tiruneh, M.D.

Department of Internal Medicine, Howard University Hospital

Yididia Bekele

Patch, Irhythm Technologies Inc

Ankit Mahajan

Cardiology, Howard University Hospital

Ahmed A. Awan

Internal Medicine, Forrest General Hospital, Hattiesburg Ms

Ahmad Awan

Department of Internal Medicine, Howard University Hospital

For correspondence:
armoghan89@yahoo.com

Bisma Ahsan

Department of Infectious Disease, Howard University Hospital

Hasan Iftikhar

Department of Internal Medicine, Howard University Hospital

Akbar Khan

Health Information Management, Howard University Hospital

Fasil Tiruneh, M.D.

Department of Internal Medicine, Howard University Hospital

Yididia Bekele

Patch, Irhythm Technologies Inc

Ankit Mahajan

Cardiology, Howard University Hospital

Ahmed A. Awan

Internal Medicine, Forrest General Hospital, Hattiesburg Ms