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

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

Oct 22, 2022 223 likes •322 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

slide-1
SLIDE 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
slide-2
SLIDE 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
slide-3
SLIDE 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

slide-4
SLIDE 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

slide-5
SLIDE 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
slide-6
SLIDE 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

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SLIDE 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

slide-8
SLIDE 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

slide-9
SLIDE 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