Is the Patient Full of It? A Case of Extreme Constipation Causing Left Ventricular Assist Device-Associated Chest Pain

Abstract

<h3>Introduction</h3> Constipation is uncommonly on the differential for chest pain. However, there have been case reports of children with idiopathic chest pain that resolved with treatment of constipation [1-2]. We present the case of an adult patient who underwent left ventricular assist device (LVAD) placement and developed severe chest pain secondary to constipation. <h3>Case Report</h3> This 57 year old man with ischemic cardiomyopathy and end stage heart failure underwent Heartmate III placement as destination therapy. On postoperative day 23 he was discharged to rehabilitation and suffered an episode of severe chest pain. He was readmitted and laboratory work, electrocardiogram, echocardiogram, and computed tomography scans were obtained. The only remarkable finding was significant colonic stool burden. Subsequently, he had several chest pain episodes that lasted 20 minutes during which, on chest palpation, several providers felt the LVAD intermittently striking the internal chest wall with each cardiac contraction. In reviewing his postoperative course, he had had almost daily stools, but his colon was not being fully evacuated (Figure 1). He was on daily magnesium oxide and polyethylene glycol, but frequently refused the latter. At readmission he required manual disimpaction and his bowel regimen was intensified. The chest pain did not recur and he was discharged six days later. <h3>Summary</h3> The gastrointestinal system can be overlooked in the postoperative care of LVAD patients, but is an important component to nutrition and recovery [3]. Although it remains important not to assume chest pain is due to constipation and miss cardiac diagnoses [4], constipation should remain on the differential for chest pain in postoperative patients.