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Echocardiogram 2007 initial echocardiogram: LV enlarged (LVIDd 7.0 - PowerPoint PPT Presentation

Oct 22, 2022 •223 likes •321 views

Echocardiogram 2007 initial echocardiogram: LV enlarged (LVIDd 7.0 cm / LVISd 6.3 cm) Severe segmental LV systolic dysfunction Estimated LVEF of 10% Mild left atrial enlargement Papillary muscle dysfunction Moderately

  1. Echocardiogram • 2007 initial echocardiogram: • LV enlarged (LVIDd 7.0 cm / LVISd 6.3 cm) • Severe segmental LV systolic dysfunction • Estimated LVEF of 10% • Mild left atrial enlargement • Papillary muscle dysfunction • Moderately – severe mitral valve regurgitation • Mild tricuspid valve regurgitation

  2. OSUWMC Ross Heart Hospital • Right / Left Cardiac Catheterization: • Right Heart Cath: • RA: A wave: 7; V wave: 2; Mean: 3 mmHg • RV: 44/8 mmHg • PA: 36/17 mmHg; Mean: 24 mmHg • PCWP: A wave: 24; V wave: 21; Mean 18 mmHg • LVEDP: 105/16 mmHg • Aorta: 104/66/73 mmHg

  3. OSUWMC Ross Heart Hospital • Left Heart Cath: • Left ventricle: global hypokinesis / LVEF = 15% • LAD: – Proximal 50% stenosis; mid 40% stenosis • LCX: – Normal • IR: – 30% stenosis • RCA: (dominant): – 30% stenosis

  4. OSUWMC Ross Heart Hospital • Cardiac MRI: – Dilated left ventricle – Severe LV systolic dysfunction – LVEF = 16% – Marked interventricular dyssynchrony – Mild to moderate mitral regurgitation – No evidence of infiltrate, scar, or iron overload

  5. Treatment • Medical therapy – ASA 325 mg po qday – Metoprolol XL 50 mg po qday – Lisinopril 10 mg po qday – Spironolactone 12.5 mg po qday – Atorvastatin 20 mg po qday • Future follow up for consideration for BiV ICD

  6. Clinical Course • Wooster Heart Group – Out patient follow up visits – Adjustment of medications: • ASA, NTG, Carvedilol, Furosemide, Spironolactone, Digoxin, ACE ‐ I • HMG CoA reductase inhibitors / Statins • Wooster Community Hospital – Multiple recurrent admissions for: • Chest pain • Dyspnea • Fatigue – Labs, ECGs, CXRs, echocardiograms – Pharmacologic stress nuclear study

  7. Clinical Course • Electrocardiograms – Sinus rhythm; LBBB • Echocardiograms – June, 2007: WCH: Est. LVEF of 15%; 3+ MR – April, 2008: WCH: Est. LVEF of 20%; 2+ MR • Pharmacologic stress nuclear study – Equivocal for a small area of myocardial ischemia in the inferior apical area vs. physiologic apical thinning

  8. OSUWMC Ross Heart Hospital • Cardiac catheterization: April 2008 – Left heart catheterization • LV pressure: 113/10 mmHg • Aortic pressure: 118/62/75 mmHg • LV: dilated with global hypokinesis & est. LVEF of 36% • Coronary anatomy: no angiographically definable disease • Electrophysiology Consultation: April 2008 – BiV ICD

  9. Clinical Course • ICD discharge: September, 2008 – 6 ICD discharges • Mowing the lawn • While emotionally upset • Electrophysiology study: September, 2008 – Left atrial tachycardia – Treatment: Amiodarone with follow up labs, CXRs, PFTs

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