Abstract
CREST syndrome is rare autoimmune disease causing calcinosis, Raynaud phenomenon, esophageal dysmotility, sclerodactyly and telangiectasias. We present a case of an eighty-two year old female with CREST syndrome who presented to our clinic with atrial fibrillation and prohibitive bleeding risk. Managing stroke risk in atrial fibrillation is essential to minimize the morbidity and mortality of the condition. Those with CREST syndrome presenting with recurrent gastrointestinal bleeding may require alternatives to anticoagulation. Recently, the left atrial appendage occluder device became widely used to manage patients at increased risk for bleeding. The device provides a safe and efficacious alternative in lowering atrial fibrillation associated stroke risk. Our patient underwent uncomplicated implantation of the left atrial appendage occluder device. She was closely monitored for one year where she remained stroke free and had one minor episode of gastrointestinal hemorrhage.
Highlights
CREST syndrome is a variant of scleroderma that is characterized by calcinosis, Raynaud phenomenon, esophageal dysmotility, sclerodactyly and telangiectasia
Atrial fibrillation raises stroke risk. it is estimated that about 87% of strokes are ischemic in nature and atrial fibrillation is the underlying cause of 15-20 % of cases [2]
We present a case of a patient with CREST syndrome who suffered from atrial fibrillation and encountered recurrent bleeding due to multiple gastrointestinal telangiectasias
Summary
CREST syndrome is a variant of scleroderma that is characterized by calcinosis, Raynaud phenomenon, esophageal dysmotility, sclerodactyly and telangiectasia. We present a case of a patient with CREST syndrome who suffered from atrial fibrillation and encountered recurrent bleeding due to multiple gastrointestinal telangiectasias. She was previously treated with a rhythm control strategy and while on amiodarone, underwent two successive cardioversions She maintained sinus rhythm for three months after the second cardioversion but presented to the hospital with increasing shortness of breath and melena and was found to have recurrent atrial fibrillation and severe microcytic anemia with a hemoglobin concentration of 6.4 grams/dl. On evaluation she was hemodynamically stable and in mild respiratory distress. She was followed for one year where she remained stroke free and had one minor episode of gastrointestinal hemorrhage
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