Circulatory Failure and Lactic Acidosis Associated with Gian
Case Report
A 74-year-old patient with known ischemic cardiomyopathy and coronary artery bypass grafting (CABG; RCA MO1-RDP) 20 years prior was referred for coronary angiography. Past medical history revealed an endovascular abdominal aneurysm repair (EVAR) and right kidney nephrectomy. Transthoracic echocardiogram 2 years before this admission showed no abnormalities.
The patient developed acute respiratory failure with mental changes and was admitted to the intensive care unit (ICU). The patient reported dyspnea for 3 days and chest discomfort on ICU admission. The vital signs showed that blood pressure (BP), pulse, respiration, oxygen saturation at room air, and temperature of 120/88 mmHg, irregular 130 beats/min, 30 cycles/min, 90%, and 36.7°C, respectively. Right- and left-sided cardiac failure was also found, which was evidenced by prominent jugular veins, congestive face, and peripheral cyanosis of the skin, with cold extremities and weak pulses...

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