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**Abstract:**

Background
The current study aimed to: (1) evaluate the prevalence of delays in first-start case times over the course of one year for trauma-related orthopedic surgery on weekends, (2) identify the cited cause for delay, and (3) estimate the cost created by delays identified in this study. We hypothesize that weekend days with first-start orthopedic trauma cases will experience delays more frequently that weekdays with similar cases.

Methods
An institutional database was used to query weekend first start OR cases from 2022-2023. Patients undergoing operative intervention for orthopedic trauma related hospital presentations were identified by retrospective chart review. Incidence and documented reasons for weekend first start cases were recorded. On-time first start case was defined as in-room time of 7:30AM.

Results
Of the 106 weekend days included in this study, 88 first-start cases were recorded, while 18 days did not have a first-start case that met the inclusion criteria outlined in this study. The mean time (AM =/- SD minutes) for assigned room, pre-op, surgeon ready, in room, OR ready, anesthesia ready, anesthesia start, and case start were 4:47 (± 2:14), 07:25 (± 0:56), 7:26 (± 0:38), 8:09 (± 0:38), 7:46 (±0:35), 8:26 (± 0:39), 8:07 (± 0:38), 8:50 (± 0:41) respectively. Of the possible causes, a reason was not recorded in 27% of cases. This was followed by patient factors, insufficient anesthesia coverage, transport, OR delays, surgeon factors, “weekend” as the stated reason, and pre-op delays. There was no notable difference in on-time first start cases based on weekend day or time of year. Of the 88 cases included in this study, the median “in room” time was 08:02. This represents a 32-minute delay based on the scheduled “in room” time of 07:30. When totaled over all 88 cases, this amounts to 2,816 minutes of delay, or roughly $84,000 in lost revenue, in first start orthopedic trauma cases on weekends in 2022. 

Conclusion

Our institution had 0% of weekend first-start cases start on time. The common occurrence of delays in weekend cases highlights the need for process improvement and schedule adjustment to maximize efficiency and personnel usage.


Evaluation of Causes and Financial Impact of Weekend Operating Room Delays at a Level 1 Trauma Center: A One-Year Retrospective Analysis

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**Abstract:**

Background and Objectives:
Elective surgery cancellations can lead to increased costs, reduced resource utilization, and patient and surgeon dissatisfaction. The reasons for why these cancellations occur remain poorly understood, hindering interventions to prevent their occurrence. Understanding these factors is necessary to implement effective strategies to reduce cancellation rates and improve surgical care delivery. This study aimed to identify the reasons for elective surgery cancellation and how these reasons can be efficiently addressed to reduce cancellation rates.

Methods & Study Design
The study focused on the General Surgery outpatient service at Grady Memorial Hospital, affiliated with Morehouse School of Medicine. We compiled a list of all requested elective surgical cases and documented the number of cases completed versus those canceled and the reasons for cancellations. Data collection occurred from July 1, 2023, to December 29, 2023. Following the appointment of a pre-procedure coordinator, a second set of data was collected from January 1, 2024, to April 22, 2024.

The reasons for cancellations were categorized into patient-related factors (e.g., no-shows, call-in cancellations, non-adherence to NPO status, failure to stop anticoagulation, unexpected illness), surgeon-related factors, missed preoperative anesthesia visits, financial clearance issues, and unknown reasons. We applied a one-sample chi-square goodness-of-fit test to calculate the chi-square statistic for data analysis. Additionally, we conducted a cost analysis to estimate the missed revenue based on average CMS reimbursements for the respective procedures. Using the collected dataset, we extrapolated the potential missed revenue over the course of a year if current trends continued.

Results
During the first five months of the study, 48 elective cases were canceled, representing approximately 30% of the scheduled elective cases. Most of these cancellations (60%) were due to missed pre-anesthesia testing or appointments (PAT) and other patient-related factors.

Following the appointment of a surgery center scheduler to assist with elective cases, there were no missed PAT appointments during the second data collection period in 2024. However, patient-related factors still accounted for most cancellations in 2024, constituting 69.2%.

Cancellations were also categorized as "intervenable" versus "non-intervenable" to evaluate the impact of system-wide deficits. Notably, 66% of the canceled cases were due to "intervenable" reasons, such as patients not showing up for scheduled pre-anesthesia testing because they were unaware of the appointments.

For the first data set, the calculated chi-square value (χ²) was 18.750, greater than the critical value of 15.09 for a degree of freedom (df) of 5, with p = 0.002. The chi-square value for the second data set was 28.462, exceeding the critical value of 11.34 for a degree of freedom (df) of 3, with p < 0.001. 


Conclusions
Since the calculated chi-square values exceed the critical values in both instances, we reject the null hypothesis (H₀), which posits that the observed proportions of surgery cancellations due to different factors are consistent with the expected proportions. This indicates that the observed proportions of surgery cancellations due to multiple dependent factors are inconsistent with the expected proportions, and the findings are statistically significant, not attributable to random chance.

The reasons for surgery cancellations differ significantly from the expected patterns based on the sample data. However, there remains a gap in the system for keeping patients informed about their pre-operative appointments and the overall pre-operative process after scheduling elective surgery. A dedicated outpatient surgery coordinator could help bridge this gap by facilitating more frequent and direct communication between patients and providers, potentially increasing the number of completed scheduled surgeries. Nonetheless, non-intervenable reasons for cancellations, such as unannounced no-shows and new onset medical conditions, will persist as challenges in elective surgery care due to their unpredictable nature and lack of easily identifiable solutions.


Analyzing Factors Contributing to Elective Surgery Cancellations: A One-Sample Chi-Square Test Approach

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**Abstract:**

Abstract Title: Unique Presentation of Diabetic Striatopathy in an Elderly Female
Background:
Diabetic striatopathy (DS), also known as hyperglycemic chorea-ballism or nonketotic hyperglycemic hemichorea-hemiballism, is a rare neurological complication predominantly seen in individuals with type 2 diabetes experiencing poorly controlled hyperglycemia. Radiologically, DS is identified by specific hyperintensities in the basal ganglia on T1-weighted MRI, and striatal hyperdensity on CT scan; a hallmark of the disease's impact on central nervous system function. Management of DS primarily focuses on rapid correction of hyperglycemia and symptomatic control of chorea. Despite strict glucose control, recurrence rates have shown to be 18.2%, making the timely diagnosis of DS a crucial component in patient management.
Case Presentation:
This report is based upon the clinical case of a 79-year-old female with a medical history of type 2 diabetes mellitus, hypertension, hyperlipidemia and dementia who presented to the emergency department (ED) with altered mental status displaying confusion, but no evidence of chorea. Preliminary workup was performed in the ED and was significant for mild tachycardia, tachypnea, and elevated blood pressure. Pertinent laboratory findings revealed hyponatremia of 130 mEq/L, hyperkalemia of 6.5mEq/L, hypocarbia with CO2 of 8mEq/L, increased anion gap of 29, elevated glucose of 796 mg/dL, increased blood urea nitrogen and creatinine of 67 mg/dL and 2.7 mg/dL. Furthermore, brain CT was performed and revealed an acute left basal ganglia hemorrhage. The patient was first admitted to the intensive care unit and then stabilized and moved to the neurological step-down unit. Repeat brain CT confirmed the diagnosis of diabetic striatopathy. Lantus was initially administered aggressively to achieve rapid glucose control and was titrated down by 5 units nightly until appropriate serum glucose was achieved. In addition, the patient was started on Glipizide, Metformin, and 10 units of Humalog sliding scale as needed. The patient's blood glucose levels showed impressive improvement during the course of her hospitalization. She was hospitalized for 10 days and her condition gradually improved. 
Discussion:
This case is a unique presentation of DS in an elderly patient with uncontrolled type 2 diabetes mellitus. Awareness of the risk factors and clinical manifestations of DS is vital for accurate assessment and effective management. Furthermore, given the likelihood of recurrence, documenting a prior diagnosis of DS is imperative for optimizing future care in patients with a history of DS.

Diabetic Striatopathy in an Elderly Female

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**Abstract:**

Title: Topical senolytic treatment with ABT-263 improves delayed wound healing of aging
Authors: Joy Ha, BA; Jannat Dhillon, BA; Rex Jeya Rajkumar Samdavid Thanapaul, PhD; Maria Shvedova, MD, PhD; Jack Crouch, BS, MS; Adam Gower, PhD; Sami Gritli, MD, PhD; Daniel S. Roh, MD, PhD.
Affiliations: Boston University School of Medicine, Division of Plastic and Reconstructive
Surgery, Department of Surgery, Boston, Massachusetts, USA

Background & Objectives:
Senescent cells (SnC) accumulate in aged tissues, limiting their ability to repair and regenerate following injury. Senolytics have been shown to promote tissue regeneration and repair when targeted at resident SnCs in certain aged tissues. We hypothesized that the removal of chronic SnCs from aged skin would improve repair potential and subsequent wound healing. This study’s objectives were to determine the effects of topical ABT-263 (navitoclax) treatment on aged skin
senescence and wound healing.
Methods:
Aged male C57Bl/6 mice (22-24 months) were treated with topical ABT-263 or control DMSO daily for 5 consecutive days. Skin was harvested at two time points: 1) immediately after 5 treatment days and 2) at day 10 (allowing for 5 days of skin recovery) and analyzed using 1) bulk RNAseq, 2) qRT-PCR and 3) histology. Additional mice treated with topical ABT-263 or control DMSO subsequently underwent 1cm full-thickness dorsal skin wounds and were imaged daily
until wound closure.
Results:
Topical ABT-263 reduced expression of p16, p21 in aged but not young skin and reduced numbers of SA-β-Gal and p21-positive cells. ABT-263 downregulated genes involved in maintaining mitochondrial homeostasis and increased pro-apoptotic genes consistent with its mechanism of action. However, there was increased inflammatory processes and cell infiltration in ABT-263 skin. GSEA analysis demonstrated ABT-263 upregulated wound healing-related pathways: ↑cell migration, ↑cell proliferation, ↑extracellular matrix synthesis and organization,
↑angiogenesis. ABT-263 treated aged mice achieved more rapid wound closure compared to controls DMSO.
Conclusions:
Topical ABT-263 reduces several senescence markers in aged skin and “primes” the skin for subsequent improved wound healing. This may involve senolysis-induced inflammation. Future work is needed to determine specific cells targeted by topical ABT-263 and the senescence-dependent vs senescence-independent mechanisms by which ABT-263 improves delayed wound healing in aging.

Topical senolytic treatment with ABT-263 improves delayed wound healing of aging

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**Abstract:**

The Uncommon Journey of a Jaundiced Patient
Ashley Dababneh DO PGY2, Radhika Garimella MD PGY1, David Minter DO

Stauffer syndrome is an uncommon paraneoplastic syndrome associated with renal cell carcinoma and is characterized by hepatic dysfunction without metastasis. Due to the rarity of its occurrence, this case should be reported to broaden a physician's differential diagnosis for hyperbilirubinemia and jaundice to correctly manage the patient. A 55-year-old male with past medical history of traumatic brain injury,cerebrovascular accident with residual left-sided weakness and seizure disorder was sent to the emergency department from his assisted living facility due to 5 days of jaundice and markedly elevated bilirubin discovered by his primary physician. Patient denied any symptomology. The physical exam was significant for jaundice and scleral icterus. Initial labs in the ER showed total bilirubin of 8.7 with a direct bilirubin of 6.67 and indirect bilirubin of 2.0 and alkaline phosphatase was 540. Computed tomography of the abdomen/pelvis demonstrated mild gallbladder thickening and intrahepatic biliary dilatation with cholelithiasis and common bile duct prominence with no obvious obstructing stone or mass. It also showed signs consistent with low-grade colitis and a mass-like attenuation of the right kidney. Ultrasound of the abdomen displayed non-specific gallbladder distention, gallstones and biliary sludge without wall thickening. Gastroenterology was consulted and further investigation showed normal gamma glutamic transferase, carbohydrate antigen 19–9, antimitochondrial antibody, and smooth muscle antibody levels. Magnetic resonance cholangiopancreatography showed a distended gallbladder with gallstones and choledocholithiasis. It also displayed a mixed signal mass measuring 3.3 X 3.8 X 3.3 cm at the mid pole of the right kidney concerning for a neoplastic process. Endoscopic retrograde cholangiopancreatography was completed, removing an obstructing gallstone and sphincterotomy was performed. The patient was scheduled for cholecystectomy after the obstructing gallstone was removed, however, due to the rising direct bilirubin, alkaline phosphatase and repeat imaging showed no signs of filling defects, the surgery was postponed. The renal mass is initially planned to be followed up outpatient, but urology was consulted due to the concern for possible Stauffer syndrome and the patient underwent a right nephrectomy. Throughout the remainder of his hospitalization his bilirubin trended down leading to improvement of his jaundice and his pathology report showed clear-cell renal carcinoma. 
This case demonstrates the need to expand was differential diagnosis and to not exclude incidental findings on imaging. The jaundice variant presentation of the syndrome is rare, but a necessary addition to the differential the patient with a renal mass concerning for neoplasm and hyperbilirubinemia.

The Unexpected Journey of a Jaundiced Patient

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**Abstract:**

Abstract Title 
Surgical Outcomes of Fresh Frozen Cartilage Use in Rhinoplasty: A Systematic Review 

Background 
Despite high satisfaction rates, rhinoplasty has a 5-15% revision rate, which is often complicated by insufficient cartilage. This challenge can be addressed with the use of cartilage grafts, including autologous cartilage and irradiated homologous costal cartilage. Recently, fresh frozen costal cartilage (FFCC) has emerged as a promising alternative, providing reduced donor site morbidity and preserved biomechanical properties. The purpose of this review is to systematically synthesize the existing literature on FFCC for rhinoplasty, focusing on surgical outcomes to inform clinicians and guide future research. 

Methods 
A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search input, “(fresh frozen) AND (rhinoplasty)” was utilized to identify relevant articles in six electronic databases: Cumulative Index to Nursing and Allied Health Literature, Excerpta Medica Database, Google Scholar, PubMed, Scopus, and Web of Science. Database searching yielded 83 records. Three independent reviewers screened and assessed identified articles based on pre-established eligibility criteria. Eligible studies reported original patient outcomes of rhinoplasty utilizing FFCC and provided sufficient data regarding outcomes. Extracted data included study design, patient demographics, technical details, and surgical outcomes. 

Results 
A total of five studies were included in the review, and collectively encompassed data for a total of 766 patients (83.9% female, 16.1% male) who underwent rhinoplasty with FFCC. This included 72 primary rhinoplasties (9.4%) and 694 revision procedures (90.6%). Across the 766 patients, there were 13 cases (1.7%) of infection, nine cases (1.2%) of warping and seven cases (0.9%) of cartilage resorption. Of studies reporting cartilage graft displacement, there was only one case (0.1%). Additionally, the reoperation rate ranged from 0.5% to 16% with an average of 2.3% (n=18) across the studies. 

Conclusion 
With comparable outcomes and low complication and reoperation rates, FFCC represents a safe and reliable alternative to autologous rib grafts for rhinoplasty. However, given the novelty of this technique, additional studies with larger patient populations and long-term follow-up are needed to validate these findings.

Surgical Outcomes of Fresh Frozen Cartilage Use in Rhinoplasty: A Systematic Review​

Education, Language, and Cultural Concordance Influence Patient-Physician Communication in Orthopaedics

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**Abstract:**

Background: Vitamin B12 deficiency (B12D) is associated with multiple risk factors and comorbidities; however, there are no firm guidelines regarding screening for B12D in the population at risk. We aimed to identify the risk factors and comorbidities associated with B12D in an adult population.
Methods: Retrospective review of adult patients who received medical care in our large urban tertiary healthcare system between 1/1/2011 to 12/31/2020. Variables were compared between the group who had B12D and those who did not (NoB12D).
Results: Patients with B12D (n=2,666) were younger than the NoB12D group (n=2,334) (62.2±18.5 vs 76.5±7.6 years; P<0.001). There were significantly higher associations in B12D group compared to NoB12D group of female sex, recreational drug use, CHF, CVA, COPD, asthma, peripheral neuropathy (PN), subacute combined degeneration of spinal cord (SCD), dementia), mild cognitive impairment (MCI), GERD, gastritis, inflammatory bowel disease (IBD), small bowel resection (SBR), colorectal surgery (CRS), bariatric surgery (BS), depression, bipolar disorder, anxiety disorder, schizophrenia, anemia, use of NSAIDs, proton pump inhibitor (PPI), histamin-2 receptor antagonist (H2RA), and lithium. Compared to White race, Black and Hispanic races had higher odds of B12D (OR 1.43, 95% CI 1.02–2.01; P=0.040, and OR 3.15, 95% CI 2.23–4.45; P<0.001, respectively). Comorbidities with greater odds of B12D included COPD and asthma (OR 1.41, 95% CI 1.12–1.78; P=0.003), anemia (OR 253.72, 95% CI 164.66–390.93; P<0.001), PN and SCD (OR 2.78, 95% CI 2.16–3.58; P<0.001), dementia and MCI (OR 3.37, 95% CI 2.40–4.74; P<0.001), gastrointestinal disorders (GERD, gastritis, IBD, SBR, CRS and BS) (OR 2.38, 95% CI 1.95–2.90; P<0.001), PPI use (OR 2.81, 95% CI 1.88–4.20; P<0.001), and NSAID use (OR 1.40, 95% CI 1.08–1.81; P=0.011).
Conclusion: Younger age, female sex, Black and Hispanic races, recreational drug use, CHF, CVA, COPD, asthma, PN, SCD, dementia, MCI, GERD, IBD, SBR, colorectal surgery, bariatric surgery, depression, bipolar disorder, anxiety disorder, schizophrenia, anemia, use of PPI, H2RA, NSAIDs and lithium are associated with B12D.

Risk Factors and Comorbidities associated with Vitamin B12 Deficiency in an Adult Population

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**Abstract:**

Authors: Lucy Nguyen, Michelle Alder, Natoshia Cunningham 

Michigan State University, College of Human Medicine, Department of Family Medicine 

Abstract Title: Assessing the Influence of ADAPT on Comorbid Anxiety and Depressive Disorders. 

Background: Functional abdominal pain disorders (FAPD) are common chronic pain conditions impacting more than 10% of youth and are associated with adverse outcomes. A tailored approach to care addressing both pain and comorbid anxiety called the Aim to Decrease Anxiety and Pain Treatment (ADAPT) has been shown to improve pain-related impairment in youth with FAPD. In this secondary analysis of the ADAPT RCT, we explored how specific mental health diagnoses MDD, GAD, social anxiety, separation anxiety, panic disorder, and OCD responded following ADAPT. 

Methods: Participants, between the ages of 9-14 diagnosed with FAPD, underwent a diagnostic interview (ADIS for DSM-IV, Child Version [ADIS-IV]). Participants were then randomized to continue treatment as usual with additional tailored cognitive behavioral therapy (ADAPT +TAU), or TAU alone. A post-assessment to assess the outcomes was done 8 weeks later. This secondary analysis is focused on participants who completed ADAPT (n=39). SPSS was utilized for data analysis. Chi-squares using Fischer’s exact tests were used to assess significant differences between the incidence of anxiety diagnoses before and after receiving ADAPT. 

Results: The number of people with GAD diagnoses significantly decreased from 20 to 10 individuals after ADAPT treatment (p < 0.001). The number of people with social anxiety diagnosis prior to ADAPT treatment was 20, which decreased significantly to 10 at the post-assessment (p<0.001). The number of people with a SAD diagnosis pretreatment was 13 which then dropped to 4 (p = 0.009). The number of people with a panic disorder diagnosis dropped from 4 to 2 (not significant). The number of OCD diagnosis from pre- to post-assessment significantly decreased from 7 to 3 (p = 0.004). 

For each depressive disorder, dysthymia and MDD, the number of depressive diagnoses in the treatment as usual group increased at the end of assessment. For those diagnosed with dysthymia in the ADAPT group, the number did not change (not significant). The number of people with MDD diagnoses dropped from 5 to 2 after ADAPT treatment (p = 0.013). 

Conclusion: Youths with FAPD and who received ADAPT demonstrated statistically significant improvement in mental health diagnoses including, major depression, dysthymia, generalized anxiety, social anxiety, separation anxiety, and OCD. CBT is often underutilized in the treatment of youth with chronic medical conditions. When addressing pain, co-occurring anxiety and depression is often overlooked although it is common and associated with poor outcomes. CBT should continue to be researched and promoted for symptom management for chronic medical issues with co-occurring psychological disorders.

Assessing the Influence of ADAPT, a Tailored Cognitive Behavioral Treatment for Youth with Functional Abdominal Pain Disorders, on Comorbid Anxiety and Depressive Disorders.​

**Scoring is only possible in the semifinals hall**

**Abstract:**

Background
University-sponsored mobile health vans are a popular method of supporting individuals with significant barriers to receiving healthcare by tailoring services to the community’s needs. Their main challenges are longevity and sustainability. Departure of an established van program from a community without other programming in place can have negative effects on the neighborhood’s health. These weaknesses must be addressed prior to developing this program.

Methods
Eight qualitative interviews were conducted with key informants to provide a deeper understanding of mobile health financing and operations sustainability. These interviews focused on the programs at five reputed university-affiliated mobile health vans in different stages of sustainability. Participants were identified through snowball sampling. All interviews were recorded using Zoom. Transcripts were coded and analyzed using NVIVO. 

Results
Four emerging themes of funding, affiliation, sustainability, and community focus were identified. A series of recommendation questions were developed from the specific findings of each theme and compiled into a guide. The main downfalls of mobile health vans stem from inconsistent funding and universities not being fully committed to communities. Vans can sidestep most limiting factors they run into by having preemptive plans in place and a clear mission statement that the university can stay grounded to. 

Conclusion
University-sponsored mobile health vans have potential if they are created with the community at the center of their intentions. The recommendations developed from this qualitative analysis will help to create a sustainability and implementation guide for university-sponsored mobile health vans and secure support for communities in need.

Creating a Sustainability and Implementation Guide for University-Sponsored Mobile Health Vans

**Scoring is only possible in the semifinals hall**

**Abstract:**

The Association of Blepharoplasty and Ptosis Repair Surgeries with the Development of Postoperative Dry Eye Syndrome (DES) 

Background
Dry Eye Syndrome (DES) poses a significant ocular health concern globally, leading to pain and visual changes that may persist for several years. This study investigates the incidence and risk factors associated with DES following four different upper eyelid surgeries: Muller's Muscle-Conjunctival Resection (MMCR), internal levator advancement and resection (internal LAR), external levator advancement and resection (external LAR), and Upper-Eyelid Blepharoplasty (UEB). Considering that these surgeries can affect the orbicularis muscle and lacrimal glands, we hypothesized that patients undergoing any of these surgeries could face an increased risk of developing DES post-operation.

Methods
Analyzing the TriNetX patient health database for surgeries conducted between 2003 and 2023, records of 4,551 patients undergoing MMCR, 4,534 patients undergoing internal LAR, 15,326 patients undergoing external LAR, and 27,696 patients undergoing UEB were examined after application of exclusion criteria. Exclusion criteria included ICD-10 codes for pre-existing DES, Meibomian gland dysfunction, Sjogren syndrome, pterygium, thyroid disease, and diabetes. Analysis encompassed linear regression to identify demographic and medical risk factors associated with post-surgical DES. Propensity score matching (PSM) facilitated pairwise outcome comparisons between the four surgeries. 

Results
Internal LAR (OR: 1.17, 95% CI: (1.057,1.296)) and external LAR ((OR: 1.07, 95% CI: (1.008,1.128)) were strongly associated with the development of postoperative DES. Post-PSM pairwise comparison analysis showed that internal LAR carried a greater risk than external LAR (RR = 1.18; 95% CI: (1.062,1.303)). UEB was strongly associated with a decreased risk of postoperative DES ((OR: 0.89, 95% CI: (0.852,0.924)), while MMCR was not significantly associated with postoperative DES (OR: 1.04, 95% CI: (0.939,1.154)). Among all four surgeries, common risk factors for postoperative DES included osteoarthritis (OA), nicotine dependence (ND), obstructive sleep apnea (OSA), and female gender, while Asian ethnicity was a risk factor only for post-UEB DES. 

Conclusion
Internal LAR and external LAR present increased risk for postoperative DES, with OA, ND, OSA, and female gender significantly influencing DES incidence. Notably, internal LAR presents a heightened risk compared to external LAR. These results can offer valuable insights for patients and healthcare providers deliberating on various ptosis repair procedures, emphasizing the critical need for thorough preoperative evaluations and tailored patient education to mitigate the risk of DES in eyelid surgical interventions.


The Association of Blepharoplasty and Ptosis Repair Surgeries with the Development of Postoperative Dry Eye Syndrome (DES)

**Scoring is only possible in the semifinals hall**

**Abstract:**

Background:
Complete heart block (CHB) is a potentially life-threatening conduction disorder characterized by the complete absence of electrical impulse transmission from the atria to the ventricles. While commonly associated with advanced age and structural heart disease, CHB can also present atypically, particularly in elderly patients. Potential consequences of delayed diagnosis of CHB can consist of syncope, heart failure and even cardiac arrest. This case report describes a 79-year-old male with a history of hypertension and tobacco abuse who presented with atypical symptoms of CHB.
Case Presentation:
A 79-year-old male with a past medical history of hypertension and tobacco abuse presented with shortness of breath of several days duration. He noted body aches, upper respiratory symptoms, and malaise during the week prior. In the past month, he reports having intermittent episodes of lightheadedness. He was previously hospitalized a few months before for similar episodes of lightheadedness, but refused workup. At home in the morning before admission, a low oxygen saturation and heart rate were noted.
On examination the patient was alert, oriented, and answering questions appropriately. He was breathing comfortably on supplemental oxygen via nasal cannula. An ECG was then performed and the patient was found to have a complete heart block with a rate in the 30s. On continuous monitoring, his heart rate continued to drop into the 20s without worsening symptoms. He was then moved to the ICU for placement of transvenous pacemaker.
The patient was not taking any pharmacological agents that could have caused his condition. A transthoracic echocardiogram showed a preserved ejection fraction. Left heart catheterization revealed non-occlusive disease. He was taken for permanent pacemaker placement which led to resolution of all symptoms.
Discussion:
This case highlights the often atypical presentation of CHB in elderly patients. While the classic presentation involves syncope or near-syncope due to bradycardia, this patient primarily reported shortness of breath and malaise. Additionally, despite experiencing prior episodes suggestive of CHB, he initially declined a workup. This stresses the need for thorough clinical evaluation in elderly patients, even when symptoms appear mild or unrelated to cardiac dysfunction. The absence of structural heart disease on echocardiogram and non-occlusive coronary arteries on angiography suggest an idiopathic or functional etiology for the CHB in this case. The prompt diagnosis and placement of a permanent pacemaker resulted in complete symptom resolution. This emphasizes the critical role of early intervention in managing CHB and preventing potential complications such as heart failure or syncope-related injuries.

Underline digital video library

Evaluation of Causes and Financial Impact of Weekend Operating Room Delays at a Level 1 Trauma Center: A One-Year Retrospective Analysis

Analyzing Factors Contributing to Elective Surgery Cancellations: A One-Sample Chi-Square Test Approach

Diabetic Striatopathy in an Elderly Female

Topical senolytic treatment with ABT-263 improves delayed wound healing of aging

The Unexpected Journey of a Jaundiced Patient

Surgical Outcomes of Fresh Frozen Cartilage Use in Rhinoplasty: A Systematic Review

Education, Language, and Cultural Concordance Influence Patient-Physician Communication in Orthopaedics

Risk Factors and Comorbidities associated with Vitamin B12 Deficiency in an Adult Population

Assessing the Influence of ADAPT, a Tailored Cognitive Behavioral Treatment for Youth with Functional Abdominal Pain Disorders, on Comorbid Anxiety and Depressive Disorders.

Creating a Sustainability and Implementation Guide for University-Sponsored Mobile Health Vans

The Association of Blepharoplasty and Ptosis Repair Surgeries with the Development of Postoperative Dry Eye Syndrome (DES)

Complete Heart Block in an Elderly Male with Atypical Presentation

Underline digital video library

Evaluation of Causes and Financial Impact of Weekend Operating Room Delays at a Level 1 Trauma Center: A One-Year Retrospective Analysis

Analyzing Factors Contributing to Elective Surgery Cancellations: A One-Sample Chi-Square Test Approach

Diabetic Striatopathy in an Elderly Female

Topical senolytic treatment with ABT-263 improves delayed wound healing of aging

The Unexpected Journey of a Jaundiced Patient

Surgical Outcomes of Fresh Frozen Cartilage Use in Rhinoplasty: A Systematic Review​

Education, Language, and Cultural Concordance Influence Patient-Physician Communication in Orthopaedics

Risk Factors and Comorbidities associated with Vitamin B12 Deficiency in an Adult Population

Assessing the Influence of ADAPT, a Tailored Cognitive Behavioral Treatment for Youth with Functional Abdominal Pain Disorders, on Comorbid Anxiety and Depressive Disorders.​

Creating a Sustainability and Implementation Guide for University-Sponsored Mobile Health Vans

The Association of Blepharoplasty and Ptosis Repair Surgeries with the Development of Postoperative Dry Eye Syndrome (DES)

Complete Heart Block in an Elderly Male with Atypical Presentation

Surgical Outcomes of Fresh Frozen Cartilage Use in Rhinoplasty: A Systematic Review

Assessing the Influence of ADAPT, a Tailored Cognitive Behavioral Treatment for Youth with Functional Abdominal Pain Disorders, on Comorbid Anxiety and Depressive Disorders.