VAPING CAN BREAK YOUR HEART

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Electronic cigarette or vaping product use-associated lung injury (EVALI) is potentially life-threatening disease that has become increasingly recognized over the last years. However, extra-pulmonary manifestations of this are not as well described. We present a patient who simultaneously developed acute EVALI and stress induced cardiomyopathy. CASE PRESENTATION: A 35-year-old female with recent heavy history presented to hospital via EMS due disorganized behavior. Her past medical was notable for polysubstance abuse an extensive neuropsychiatric history. vital signs were sinus tachycardia, hypotension hypoxia oxyhemoglobin saturation 65%. physical exam cyanosis, rales pulmonary auscultation use accessory muscles. She intubated started on empiric antibiotics community acquired pneumonia, vasopressors. computer tomography angiography (CTPE) negative embolism but showed scattered bilateral airspace opacities dependent consolidations (fig 1.). Relevant laboratory admission included procalcitonin 28.17, WBC count 12.9 troponin 1.58. SARs-COV-2, serum blood cultures, legionella antigen, streptococci pneumoniae antigen HIV negative. Urine toxicology positive cannabinoids. Bronchoalveolar lavage later demonstrated 50,000 TNC neutrophil predominance. EKG tachycardia nonspecific ST depression. Echocardiogram revealed severe diffuse hypokinesis left ventricular ejection fraction (LVEF) 13%. During her ICU course she continued mechanical ventilation protective strategy, systemic glucocorticoids antibiotics. Vasopressors subsequently weaned off. Repeated echocardiogram day five recovered LVEF at 55%. Patient's hypoxemia improved, successfully extubated eight. DISCUSSION: Pulmonary most described clinical manifestation EVALI, however large majority these patients also gastrointestinal symptoms malaise, suggesting process. Our had newly reduced suggestive cardiomyopathy which consequently improved standard supportive care. CONCLUSIONS: It important maintain high index suspicion secondary organ damage, prompt diagnosis treatment associated cardiac dysfunction can have impact in short- long-term prognosis. REFERENCE #1: Kligerman S, Raptis C, Larsen B, Henry TS, Caporale A, Tazelaar H, Schiebler ML, Wehrli FW, Klein JS, Kanne J. Radiologic, Pathologic, Clinical, Physiologic Findings Cigarette Vaping Product Use-associated Lung Injury (EVALI): Evolving Knowledge Remaining Questions. Radiology. 2020 Mar;294(3):491-505. doi: 10.1148/radiol.2020192585. Epub Jan 28. PMID: 31990264. DISCLOSURES: No relevant relationships by David barounis, source=Web Response Xavier Fonseca, Dana Mueller,