**Meeting Allocation Details** * **Assigned Date & Time:** 17/09/2026, 14:00–15:00 * **Meeting Chair:** Brian Williams * **Assigned Case:** MRN 02939815 (APM) * **Presenter:** Bhavin Shah * **Microsoft Teams Details:** Meeting ID `361 429 793 331 110`, Passcode `g4jS9jo7` --- ### Slide 1: Title Slide * **Title:** CTCCU Morbidity and Mortality Case Review * **Patient:** APM | Hospital Number: 02939815 * **Presenter:** Dr. Bhavin Shah (Clinical Fellow, CTCCU) * **Meeting Date:** 17/09/2026 --- ### Slide 2: Patient History & Baseline * **Demographics:** 58-year-old female, high school teacher, functionally independent at baseline. * **Admission Date:** Transferred to Wythenshawe Hospital on 03/04/2026 (initially admitted to Royal Oldham Hospital on 14/03/2026). * **Key Comorbidities:** * Definite Antiphospholipid Syndrome (APS) with prior DVT in 2024, maintained on warfarin. * Systemic connective tissue disease (positive ANA, dsDNA, anti-cardiolipin, beta-2-glycoprotein IgG, low C3/C4). * Immune thrombocytopenia (ITP): Long-term steroid dependence weaned off in January 2026 and transitioned to avatrombopag. * Interstitial lung disease (ILD): Restrictive pattern on spirometry; baseline ground-glass opacities. * Severe obesity (133 kg), chronic bilateral lower limb lymphoedema, hypothyroidism, and non-epileptic attack disorder. * **Adverse Outcome:** Refractory cardiogenic and vasoplegic shock culminating in pulseless electrical activity (PEA) arrest and death on 03/04/2026. --- ### Slide 3: Clinical Timeline & Events (Oldham to Cath Lab) * **14/03/2026 – 02/04/2026 (Royal Oldham Hospital):** * Admitted with a 2-day acute deterioration in breathlessness following a 3-month decline after steroid cessation. * Treated empirically for community-acquired pneumonia and CTD-ILD flare (antibiotics, hydrocortisone). * CT venogram (25/03) suggested left cavernous sinus thrombosis. * Serial high-sensitivity troponin T elevation: 66 $\rightarrow$ 3,992 $\rightarrow$ 8,771 $\rightarrow$ 11,339 ng/L. * Echo (26/03) identified new left ventricular systolic impairment with regional wall motion abnormalities. * **03/04/2026 (Coronary Angiography):** * Emergency Level 3 transfer intubated for presumed inferior/posterior STEMI / acute coronary syndrome. * Right radial angiogram confirmed unobstructed, angiographically normal coronary arteries (no culprit vessel). --- ### Slide 4: Critical Care Systems Summary (Wythenshawe CTCCU) * **Airway & Breathing:** Intubated (Size 8 ETT) on SIMV, FiO2 1.0, PEEP 15 cmH2O; severe hypercapnic/respiratory acidosis (ETCO2 7.5 kPa); inhaled nitric oxide initiated at 20 ppm. * **Circulation:** * Bedside TOE confirmed severe biventricular failure (LVEF ~25%), severe LV dilatation (LVIDD 64 mm), and moderate central mitral regurgitation. * Refractory mixed shock requiring escalating multi-agent support: double-strength noradrenaline, vasopressin, adrenaline infusion, milrinone, and albumin fluid boluses. * **Neurology
**Meeting Allocation Details** * **Assigned Date & Time:** 17/09/2026, 14:00–15:00 * **Meeting Chair:** Brian Williams * **Assigned Case:** MRN 02939815 (APM) * **Presenter:** Bhavin Shah * **Microsoft Teams Details:** Meeting ID `361 429 793 331 110`, Passcode `g4jS9jo7` --- ### Slide 1: Title Slide * **Title:** CTCCU Morbidity and Mortality Case Review * **Patient:** APM | Hospital Number: 02939815 * **Presenter:** Dr. Bhavin Shah (Clinical Fellow, CTCCU) * **Meeting Date:** 17/09/2026 --- ### Slide 2: Patient History & Baseline * **Demographics:** 58-year-old female, high school teacher, functionally independent at baseline. * **Admission Date:** Transferred to Wythenshawe Hospital on 03/04/2026 (initially admitted to Royal Oldham Hospital on 14/03/2026). * **Key Comorbidities:** * Definite Antiphospholipid Syndrome (APS) with prior DVT in 2024, maintained on warfarin. * Systemic connective tissue disease (positive ANA, dsDNA, anti-cardiolipin, beta-2-glycoprotein IgG, low C3/C4). * Immune thrombocytopenia (ITP): Long-term steroid dependence weaned off in January 2026 and transitioned to avatrombopag. * Interstitial lung disease (ILD): Restrictive pattern on spirometry; baseline ground-glass opacities. * Severe obesity (133 kg), chronic bilateral lower limb lymphoedema, hypothyroidism, and non-epileptic attack disorder. * **Adverse Outcome:** Refractory cardiogenic and vasoplegic shock culminating in pulseless electrical activity (PEA) arrest and death on 03/04/2026. --- ### Slide 3: Clinical Timeline & Events (Oldham to Cath Lab) * **14/03/2026 – 02/04/2026 (Royal Oldham Hospital):** * Admitted with a 2-day acute deterioration in breathlessness following a 3-month decline after steroid cessation. * Treated empirically for community-acquired pneumonia and CTD-ILD flare (antibiotics, hydrocortisone). * CT venogram (25/03) suggested left cavernous sinus thrombosis. * Serial high-sensitivity troponin T elevation: 66 $\rightarrow$ 3,992 $\rightarrow$ 8,771 $\rightarrow$ 11,339 ng/L. * Echo (26/03) identified new left ventricular systolic impairment with regional wall motion abnormalities. * **03/04/2026 (Coronary Angiography):** * Emergency Level 3 transfer intubated for presumed inferior/posterior STEMI / acute coronary syndrome. * Right radial angiogram confirmed unobstructed, angiographically normal coronary arteries (no culprit vessel). --- ### Slide 4: Critical Care Systems Summary (Wythenshawe CTCCU) * **Airway & Breathing:** Intubated (Size 8 ETT) on SIMV, FiO2 1.0, PEEP 15 cmH2O; severe hypercapnic/respiratory acidosis (ETCO2 7.5 kPa); inhaled nitric oxide initiated at 20 ppm. * **Circulation:** * Bedside TOE confirmed severe biventricular failure (LVEF ~25%), severe LV dilatation (LVIDD 64 mm), and moderate central mitral regurgitation. * Refractory mixed shock requiring escalating multi-agent support: double-strength noradrenaline, vasopressin, adrenaline infusion, milrinone, and albumin fluid boluses. * **Neurology
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This case study explores a patient's journey through critical health challenges, beginning with their baseline profile and risk factors for various conditions. It details the clinical deterioration marked by breathlessness and cardiac dysfunction, despite normal coronary findings. The focus shifts to the crisis in the CTCCU, highlighting severe biventricular failure and the need for advanced support measures. Key learning points include identifying escalation strategies and enhancing system...