Chicago Hemo Forum Case 111425f.pptx

1、Chicago hemodynamic forum74 year-old nurse with dyspnea,James C.Fang,MDProfessor and CHiefDivision of Cardiovascular MedicineExecutive director,Cardiovascular service lineUniversity of UtahSalt Lake City,UT,74 year-old retired nurse with exertional dyspnea,Began 2 years ago;in past 6m worse,no resti

2、ng issues.Also notes some exertional and nonexertional chest pressure.No LH or syncope although gets dizzy when she gets winded.Lives alone;activities limited to horse riding.BP at home 110-120s.No smoking,drinking,drugs/OTC meds.+HTN,+DM,+DL,+CAC;no MI/CVA,stress test,cath.Widowed,lives alone,2 adu

3、lt children.Father,2 brothers with CAD in their 60s.Meds:ASA,atorva,metformin,semaglutide,lisinopril,metformin,data,Exam 117/78,HR 73,57”,160,BMI 25 otherwise normalLabs:normal.BNP 34.Normal EKG,normal CXR.Stress echo:Bruce 5:44;7 METs.HR 73=133 bpm;SBP 142=178 mmHg.No ischemia by EKG/echo.Baseline

4、echo normal except RVSP 45 mmHg.,Supine exercise RHC,At rest:HR 58 bpm NSR;BP184/81(117)mmHg.RA 4 mmHg.RV 36/0,5 mmHg.PA 34/10(19)mmHg.PCWP 11 mmHg.Indirect Fick CO 5.0 L/min CI 2.7 L/min/m2(PA sat 61.3%;SVC sat 58%)Thermodilution CO 3.8 L/min CI 2.1 L/min/m2PVR 2.1 WU,SVR 2378 dynes/seconds/cm-5,Co

5、ndition 3 65W HR=114 bpmRA 10PA 71/29(49)PCWP 28CO/CI TD 10.3/5.6Condition 4 85W(peak exercise)HR max 122 bpmRA 14PA 75/33(51)PCWP 19CO/CI TD 10.9/5.9,Condition 1 25W HR=91 bpmRA 8PA 59/25(41)PCWP 29CO/CI TD 8.2/4.5Condition 2 45W HR=103 bpmRA 10PA 67/26(45)PCWP 24CO/CI TD 9.9/5.4,What is normal with supine exercise?,Kovacs G,et al.Eur Resp J 2009,