Abstract We present a case of a 67-year-old woman with a significant history of chronic silica exposure. She presented with symptoms and signs of acute heart failure secondary to pulmonary hypertension (PH). The patient, a former worker in an industry involving prolonged silica exposure (pottery), developed progressive dyspnea, fatigue, orthopnea, and bilateral pedal edema over the last month. This culminated in an acute exacerbation requiring hospitalization.Clinical examination revealed an elevated jugular venous pressure, bilateral pedal edema, and an accentuated second pulmonic heart sound, consistent with Right heart failure. Laboratory results showed elevated brain natriuretic peptide (BNP) levels, and an electrocardiogram indicated right ventricular hypertrophy. A transthoracic echocardiogram estimated elevated right ventricular systolic pressure and right ventricular enlargement with normal left ventricular function.Chest imaging, including high-resolution computed tomography (HRCT), revealed extensive bilateral granulomas, pronounced in the upper lobes. There was significant mediastinal lymphadenopathy and pericardial effusion. Right heart catheterization confirmed pre-capillary pulmonary hypertension.The diagnosis of silicosis-induced pulmonary hypertension leading to RHF was established after an extensive workup to exclude other causes of PH, such as connective tissue disease or idiopathic pulmonary arterial hypertension, which are more common in elderly women. The patient’s acute presentation of RHF was attributed to the severe pressure load on the right ventricle caused by the chronic, progressive vascular remodeling and fibrosis associated with her long-term silica exposure.This case highlights the late-stage vascular complications of chronic silicosis, even decades after exposure cessation. It underscores the importance of a detailed occupational history and a high index of suspicion for occupational lung diseases in elderly patients presenting with unexplained PH and RHF, to facilitate timely diagnosis and management, and prevent similar outcomes in others through effective prevention strategies. This abstract is funded by: NONE
Bari et al. (Fri,) studied this question.