Case History / Examination
A 41-year-old female presented to the emergency with a history of
dizziness for 6 hours, shortness of breath for 1 day and chest pain and
shortness of breath characterized by orthopnea and paroxysmal nocturnal
dyspnea for the past 2 weeks. She had been under regular maintenance
hemodialysis for end-stage renal disease (ESRD), secondary to systemic
hypertension of 17 years, for the past 6 months. An autogenous
brachiocephalic arteriovenous fistula (AVF) was created on her left arm
10 months back citing future requirement for hemodialysis. Although
renal transplantation had been contemplated, a proper match had not been
found. The patient had had her regular scheduled hemodialysis 2 days
before her visit to the emergency. There was no history of trauma to the
AVF.
At presentation, vital signs included a bradycardia of 46/m, blood
pressure of 60/40 mm of Hg, SpO2 of 86% in room air, respiratory rate
of 16/m and she was afebrile. She was drowsy, but oriented to time,
place and person. No focal neurological deficits were evident and there
were no flaps. Heart sounds were muffled and jugular venous distension
was obvious. No bruit was appreciated in her native AVF.