Probably a combination of MR, the degree is difficult to tell with the acoutic shadowing from MAC but the LA is quite large, probable diastolic dysfunction, and very mild left sided inflow and outflow obstructions leading to a high LVEDP.
Be careful to blame mildly increased LVOT velocity for an 'obstruction' to outflow; that is just higher velocity due to LVH/HTN and the real culprit is the resulting impaired relaxation or "diastolic dysfunction".
She doesn't have MS, its MAC, the leaflets are moving. There is Dias dysfunction, and the mean gradient of the MV looks about 5 or 6 mmhg. Its probably a combination of reduced LVOT size due to the ASH and SAM, and the increased mean gradient of the MV inflow.
Maybe chordal SAM, but not of the whole leaflet. Ao velocity 1.5-no rest gradient. So she has some MS, sev LVH, and known CAD. I would get a Cardiac CT to asses grafts first;with such LVH stress echo is hard to read, and with CAD and LVH, nuclear perfusion also problematic. If no ischemia, then would get Cardiopulmonary Stress test to see if it is part or all pulmonary/deconditioning.If still cardiac,exercise echo doppler to r/o significant MS.If all neg, its likely diast dysfunc form LVH...
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Humain or Animal ??
grenouil1970 3 years ago
Human!
alamotanguero 3 years ago
human
alamotanguero 3 years ago
Probably a combination of MR, the degree is difficult to tell with the acoutic shadowing from MAC but the LA is quite large, probable diastolic dysfunction, and very mild left sided inflow and outflow obstructions leading to a high LVEDP.
get30inc 4 years ago
Be careful to blame mildly increased LVOT velocity for an 'obstruction' to outflow; that is just higher velocity due to LVH/HTN and the real culprit is the resulting impaired relaxation or "diastolic dysfunction".
alamotanguero 4 years ago
She doesn't have MS, its MAC, the leaflets are moving. There is Dias dysfunction, and the mean gradient of the MV looks about 5 or 6 mmhg. Its probably a combination of reduced LVOT size due to the ASH and SAM, and the increased mean gradient of the MV inflow.
merigirl2 4 years ago
SAM
agathakwon 5 years ago
Maybe chordal SAM, but not of the whole leaflet. Ao velocity 1.5-no rest gradient. So she has some MS, sev LVH, and known CAD. I would get a Cardiac CT to asses grafts first;with such LVH stress echo is hard to read, and with CAD and LVH, nuclear perfusion also problematic. If no ischemia, then would get Cardiopulmonary Stress test to see if it is part or all pulmonary/deconditioning.If still cardiac,exercise echo doppler to r/o significant MS.If all neg, its likely diast dysfunc form LVH...
alamotanguero 5 years ago
Restrictive filling pattern at mitral inflow consistent with severe diastolic dysfuntion
muksy 5 years ago
partial answer...partial credit!
alamotanguero 5 years ago
HOCM
bigdaddymeloncamp 5 years ago
at 83? with normal AV velocity? LVH is likely part of the sxs however...
alamotanguero 5 years ago
unlikely...keep trying!
alamotanguero 5 years ago
severe calcific mitral stenosis
bigdaddymeloncamp 5 years ago