Iliofemoral Venous Obstruction presenting as Inappropriate Sinus

Tachycardia
Navya Reddy1, Nagender Reddy2
1
University of Missouri-Kansas City, 2Lorven Heart and Vascular Center

INTRODUCTION

METHODS

More than 20% of patients with

chronic venous insufficiency (CVI)
have obstruction of the iliofemoral or
iliocaval veins. However, iliofemoral
venous obstruction remains one of
the most undertreated conditions
worldwide, as the clinical
manifestations are diverse and poorly
understood.

A 40 year old female presented to her

physician with recurrent episodes of
palpitations, near syncope and fatigue
for more than five years, exacerbated by
minimal activity. She reported chronic
fatigue, lower back pain radiating to the
posterior thighs and bilateral leg
swelling. She denied prior cardiac
history. Holter monitoring revealed
resting heart rates in the 120s-130s and
150s with minimal activity. CMP, CBC
and thyroid function tests were normal.
Physical examination was consistent
with overweight habitus, ankle edema,
hyperpigmentation, cold lower
extremities and pre-ulceration, with high
CEAP and VCSS scores. Echocardiogram
revealed an EF > 65% and no valvular
heart disease. A diagnosis of
inappropriate sinus tachycardia (IST)
was made.

External compression resulting in

iliofemoral obstruction due to MayThurner Syndrome, pregnancy,
bladder distension, common iliac
artery aneurysms, endometriosis and
malignancy, has been associated
with independent adverse cardiac
outcomes.

Vascular evaluation with venous

ultrasound and mapping revealed loss of
phasic waves and significant blunting of

CONCLUSION
This case demonstrates that
iliofemoral venous obstruction may
result in significant preload reduction,
resulting in IST as a compensatory
response to maintain cardiac output.
Patients with signs/symptoms of CVI
and associated tachyarrhythmias
should be evaluated for iliofemoral
venous obstruction, as it may
significantly impact preload status and
correlate with negative cardiac
outcomes such as resulting
tachycardia.
Further large scale studies can prove
to be valuable in understanding the
association between iliofemoral venous
obstruction and
its effects on cardiac
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South Med J 1995.
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enlargement simulating DVT. J Vasc Surg 1999.
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urinary bladder in a male with paraplegia due to spinal cord injury. Spinal
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Obstet Gynaecol Can 2002;24:33-5.