North Texas Research Forum 2025
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Division
North Texas
Hospital
Medical City Arlington
Specialty
Internal Medicine
Document Type
Poster
Publication Date
2025
Keywords
vaping, pectus excavatum, congenital chest wall abnormality, young adults
Disciplines
Cardiovascular Diseases | Congenital, Hereditary, and Neonatal Diseases and Abnormalities | Internal Medicine | Medicine and Health Sciences
Abstract
Pectus excavatum (PE), characterized by an inward depression of the sternum, is the most common congenital chest wall abnormality. It has been rarely linked to cardiac abnormalities, such as arrhythmias and sudden cardiac arrest (SCA). In addition, emerging research suggests that vaping is a cardiovascular risk factor that has the potential to destabilize cardiac rhythm and promote arrhythmias. There is a lack of FDA oversight and long-term research on the effects of vaping. The rising popularity of vaping among youth, coupled with misconceptions about its safety, underscores the urgent need to understand the potential interactions vaping has in precipitating fatal arrhythmias and SCA. This is especially crucial in higher-risk populations, such as those with chest wall deformities like PE. CASE PRESENTATION A 20-year-old Arabic man with a known diagnosis of PE and no family history of SCD presented after experiencing an out-of-hospital cardiac arrest due to ventricular fibrillation (VF). His medical history included daily vaping and infrequent marijuana use. Additionally, he reported a significant tobacco history, beginning with occasional cigarette use at age 11 and escalating to 1-2 packs per day from ages 17-19. He was found unresponsive in his car, surrounded by multiple vaping devices. On arrival of emergency services, he was pulseless, with the initial rhythm indicating VF. After two rounds of cardiopulmonary resuscitation (CPR) and successful defibrillation, return of spontaneous circulation (ROSC) was achieved. He was intubated at the scene and subsequently transferred to the intensive care unit (ICU) for further management. Initial diagnostic workup, including brain imaging, computed tomography (CT) of the chest, spine, abdomen, and pelvis showed no acute abnormalities except for left lower lobe consolidation. The electrocardiogram (EKG) displayed sinus rhythm with a QTc of 484 ms. Urine toxicology tests were negative. A transthoracic echocardiogram (TTE) revealed mildly reduced systolic function of the left ventricle with an ejection fraction (EF) of 40–45% and septal wall hypokinesis. The patient was successfully extubated and gradually regained neurological function over the following days. Telemetry monitoring during the hospital course did not reveal any significant tachyarrhythmias. A cardiac MRI identified the PE as a chest wall abnormality causing geometric distortion on the right side of the heart, but no signs of arrhythmogenic right ventricular cardiomyopathy were observed. Coronary angiography showed no significant coronary artery disease or aortic stenosis. A corrective surgical plan for the PE and placement of an implantable cardiac device were coordinated between the electrophysiology and cardiothoracic surgery teams to prevent further episodes of cardiac arrest. DISCUSSION PE has been associated with an increased risk of arrhythmias due to mechanical compression of the heart. Individuals with PE may experience arrhythmias such as ventricular tachycardia and atrial fibrillation, though the exact mechanisms remain unclear. Additionally, recent research has raised concerns about the potential link between vaping and arrhythmias, attributable to various mechanisms, including the effects of nicotine and other chemicals on the cardiovascular system. In our case, the patient’s history of vaping and subsequent cardiac arrest from ventricular fibrillation highlights the importance of considering both PE-related arrhythmias and potential cardiovascular risks associated with vaping. While arrhythmias in patients with isolated PE are relatively rare, the combination of PE and vaping may increase the risk significantly. Further research is needed to elucidate the precise mechanisms and prevalence of arrhythmias in these populations, but surveillance in cardiac health is crucial, especially in individuals with these risk factors.
Original Publisher
HCA Healthcare Graduate Medical Education
Recommended Citation
Gala, Anoop; Van, Nga; Rustom, Grace; Ford, Danielle; and Nguyen, Phuc, "A Vaping Nightmare: Sudden Death Provoked by Vaping in the Setting of Pectus Excavatum" (2025). North Texas Research Forum 2025. 108.
https://scholarlycommons.hcahealthcare.com/northtexas2025/108
Included in
Cardiovascular Diseases Commons, Congenital, Hereditary, and Neonatal Diseases and Abnormalities Commons, Internal Medicine Commons