Case.pptx

1、Dyspnea Workup,Marat Fudim,Case,58F remote Hodkins lymphoma with extensive radiation c/b baroreflex failure,R subclavian stenosis,CHB s/p PPM,who was referred for shortness of breathReports widely variable BP,mainly elevatedHas not tolerated BP meds wellIntermittently on midodrineCMRI without ischem

2、ia/infarct 3 mo prior to presentation,TTE,CONCLUSION-NORMAL LEFT VENTRICULAR SYSTOLIC FUNCTION WITH MILD LVHESTIMATED EF:55%,CALC EF(3D):51%INDETERMINATE DIASTOLIC FUNCTIONNORMAL RIGHT VENTRICULAR SYSTOLIC FUNCTIONVALVULAR REGURGITATION:MILD AR,MILD MR,No PR,MODERATE TRESTIMATED RVSP:59 mmHg(ABNORMA

3、L)VALVULAR STENOSIS:No AS,MILD MS,No PS,No TS,Orthostatics,In Pre-OP vitalsSitting:HR 109,BP 228/100Standing:HR 92,BP 230/73,Supine:,Legs Up Hemodynamics-RIGHT PARA 10PA 60/30PCWP 30,tall V CO 6,CI 3.6,PVR 1.8SBP 238/93(151),Legs Up Hemodynamics-LEFT PARA 10PA 57/29 PCWP 36,tall VSBP 237/101(146),Ni

4、tro,Legs Up Hemodynamics-Nitroglycerin 20 mcg/minRA 9PA 60/33PCWP 25SBP 239/100(157),Legs Up Hemodynamics-Nitroglycerin 40 mcg/minRA 5PA 45/25PCWP 17SBP 229/94(139)Started coughing with pink/frothy sputum,Supine Exercise,Nitroglycerin 40 mcg/min0 WattsRA 7PA 43/22PCWP 17CO 7.6,CI 4.6,PVR 1.7SBP 229/

5、94(139),Nitroglycerin 40 mcg/min20 WattsRA 9PA 55/28PCWP 23CO 7.2,CI 4.3,PVR 2.4SBP 239/95(143),Invasive Case,Nitroglycerin off,UprightRestRA 0PA 32/10PCWP 5CO 5.3,CI 3.2,PVR 1.9SBP 207/80(122),20 WattsRA 0PA 50/22PCWP 16CO 6.9,CI 4.2,PVR 2SBP 244/84(137),50 Watts(peak)RA 0PA 47/24PCWP 17CO 8.6,CI 5.2,PVR 1.6SBP 242/81(135),CPET,