Subject: Re: Case of Severe CHF
Forum: The Heart Forum
Topic Area: Echocardiography
Posted by CCF CARDIO MD - DLB on November 18, 1998 at 13:08:02:
In Reply to: Case of Severe CHF posted by Don on November 18, 1998 at 03:00:49:

I was hospitalized during the first week of May this year with CHF and started on a different medication regimen that consists of Lanoxin 0.25 mg BID, Coreg 6.25 mg BID, Coumadin (varies according to standing order PTs), potassium OS 1 tbsp. TID, mag. ox. 400 mg BID, and Lasix 40 mg BID. No cardioversion was attempted; apparently, I was not considered a good
candidate for this procedure. An echocardiogram was done with the following findings:

ECHOCARDIOGRAM:
TECHNICALLY LIMITED STUDY DUE TO THE PATIENTS BODY HABITUS.
Two-dimensional as well as color flow imaging and conventional Doppler were performed on this
patient.
INTERPRETATION
1. Calcified aortic annulus, particularly the left coronary leaflet with slightly decreased but adequate excursion. Doppler examination reveals peak systolic gradient of 15 mmHg with a mean gradient of 10, with moderately severe diastolic regurgitation. The calculated aortic valve area by Doppler is 1.8 centimeters squared. Normal sized aortic root.
2. Borderline enlarged left atrium measured at 4.1 cm.
3. Mild diffuse thickening of the mitral leaflets with adequate excursion with diastolic fluttering of the anterior leaflet consistent with aortic regurgitation. Doppler exam reveals moderately severe mitral regurgitation which seems to be a more eccentric jet toward the posterior atrial wall.
4. Markedly dilated left ventricle with end diastolic dimension measured at 7.1 cm. There is severe global hypokinesis with the ejection fraction estimated at 20%.
5. Normal sized right ventricle.
6. Normal tricuspid valve with mild tricuspid regurgitation by Doppler. The right ventricular systolic pressure is estimated at 38 mmHg, assuming CVP of 10. This indicates the presence of mild pulmonary hypertension.
7. There is no pulmonic regurgitation by Doppler.
8. No pericardial effusion seen.

IMPRESSION
1. Calcifications of the aortic valve with decreased but adequate excursion and mild systolic gradient by Doppler with moderately severe aortic regurgitation.
2. Moderately severe mitral regurgitation.
3. Dilated and severely hypokinetic left ventricle with ejection fraction estimated at 20%.

*This test was done two days after first May 1998 hospitalization.

I was hospitalized again the last week in May with severe dyspnea. This admission was considered medical rather than cardiac. I received an IV antibiotic (Azogantrisin, I think), IV Solu-Medrol,breathing treatments, ABGs, and my present cardiac medicines. PFT results showed 85% 02 sat.
Upon my release, 02 sat. was 95% on room air. In addition, a Doppler was done on the previous echo, which had been done earlier in May. The findings appear below.

ECHOCARDIOGRAM
TECHNICALLY LIMITED STUDY DUE TO THE PATIENTS BODY HABITUS.

Doppler was performed on the previous study of May 4, 1998.

INTERPRETATION
1. Normal aortic root dimensions.
2. Moderate thickening of the aortic valve typical for calcification with decreased excursion.
3. Minimal left atrial dilatation, 4.1 cm.
4. Normal mitral and tricuspid valves.
5. Moderate to marked left ventricular dysfunction, 6.7 cm. With moderate symmetrical hypertrophy. There is global diffuse hypokinesis with an estimated ejection fraction of 20%.
6. Mild right heart dilatation.
7. No pericardial effusion.

*This test was performed on Day 2 of my second admission.

I have three questions and any information given will be appreciated.
1. Will you please expound briefly on the following points and how they relate to the interpretation of my echocardiogram?
a. Aortic regurgitation.
b. Moderately severe mitral regurgitation . . . toward posterior atrial wall.
c. Markedly dilated left ventricle.
d. Severe global hypokinesis.
e. Ejection fraction estimated at 20%.
f. Calcified aortic valve.
2. Since I am taking the appropriate medications to increase cardiac efficiency, in your opinion, will the global hypokinesis and the left ventricular hypertrophy and dysfunction be erradicated or just decreased in their severity?
3. What is the difference between acute CHF and chronic CHF?
4. My mother has atrial fibrillation as well. Is there proof this condition is hereditary?

I realize that it would require too much space to answer all my questions, but any information regarding these issues will be greatly appreciated.

Thank you,
Don


Dear Don

1a. This refers to a leaky aortic valve.
1b. This refers to a leaky mitral valve.
1c. Your heart's main pumping chamber is enlarged.
1d. All the different parts of your heart's main pumping chamber are weak.
1e. Your heart is working at about one third of normal.
1f. Your aortic valve has calcium deposited on it. This interferes with its ability to open and close normally.
2. I think the appropriate medicines will help get your heart in better shape. I doubt that medicines alone will bring your heart back to normal. Are you on an ACE inhibitor?
3. Acute CHF refers to a sudden onset of symptoms such as shortness of breath. Chronic CHF refers to ongoing symptoms of shortness of breath, swelling, fatigue, etc.
4. Atrial fibrillation is not usually hereditary. There are some families in which it is hereditary. There are also some families in whom heart failure is hereditary.

I hope this is useful. Feel free to write back with further questions. Good luck.

If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter. The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.

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