title: Paradoxical respiratory sinus arrhythmia due to a large thoracic empyema in an ambulatory patient.
abstract: We report a case of paradoxical respiratory sinus arrhythmia (PRSA) caused by a retro-cardiac empyema in an ambulatory patient. The case describes the dynamics and deleterious impact of PRSA on cardio-respiratory cycle, its electrocardiographic, radiologic and echocardiographic findings. Furthermore, it discusses a probable mechanism of paradoxical respiratory sinus arrhythmia in the setting of a retrocardiac mass and suggests a need for physicians to check for the changes in ventilation perfusion mismatch and rise in physiological dead space in such patients. In conclusion, to the best of our knowledge, this is the first documented report of paradoxical respiratory sinus arrhythmia in an ambulatory, non-anesthetized spontaneously breathing patient.
authors.affiliation: Department of Medicine, Allama Iqbal Medical College/Jinnah Hospital, Lahore, Pakistan. Electronic address: dr.zamankhan@yahoo.com.
authors.forename: Muhammad Zaman Khan
authors.initials: MZ
authors.lastname: Assir
authors.affiliation: Department of Medicine, Allama Iqbal Medical College/Jinnah Hospital, Lahore, Pakistan. Electronic address: malikfaheem.md@gmail.com.
authors.forename: Malik M
authors.initials: MM
authors.lastname: Faheem
authors.affiliation: Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States. Electronic address: BrenesSalazar.Jorge@mayo.edu.
authors.forename: Jorge A
authors.initials: JA
authors.lastname: Brenes-Salazar
authors.affiliation: Department of Medicine, Allama Iqbal Medical College/Jinnah Hospital, Lahore, Pakistan. Electronic address: tariqwaseem_59@hotmail.com.
authors.forename: Tariq
authors.initials: T
authors.lastname: Waseem
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D004562:Electrocardiography; D016724:Empyema, Pleural / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011859:Radiography; D065809:Respiratory Sinus Arrhythmia / Q000502:physiology*
keywords: Bi-ventricular outflow tract obstruction; Cardio-respiratory autonomic interplay; Empyema; Paradoxical respiratory sinus arrhythmia; Retro-cardiac mass