Novel Electrocardiographic Changes Associated With Iatrogenic Pneumothorax

Abstract

56-year-old woman (height 165 cm, weight 65 kg) was admitted to the hospital because of a 2-day history of epigastric pain and emesis. Two weeks prior to admission, she had a Billroth II with Roux-en-Y procedure for stomach stricture and biliary reflux. Her medical history was significant for 1 episode of atrial fibrillation many years previously, osteoporosis, bilateral hip replacements, and gastric ulcer surgery. Drug therapy at the time of admission included simethicone 80 mg/d, rabeprazole 10 mg/d, and as-needed doses of clonazepam for anxiety and of acetaminophen. At admission, the patient’s blood pressure was 120/70 mm Hg and her heart rate was 90/min and regular. The physical examination was notable for facial and conjunctival pallor. Mucous membranes were dry. The patient’s abdomen was distended and tender to palpation in the upper quadrants. Bowel sounds were decreased. Her extremities were cool and her peripheral pulses were weak. The abdominal surgical wound was healing. The patient denied any cardiopulmonary symptoms and the results of her neurological examinations were normal. The patient’s white blood cell count was slightly elevated at 10.9 x 10 9 /L, and her hemoglobin level