4yr
81-year-old female with a history of atrial fibrillation and mild left ventricular dysfunction presents at ED with functional class IV dyspnea (NY Heart Association) which began several weeks ago as mild dyspnea on exertion but has progressed rapidly. She was worked up by a cardiologist a year ago after a brief hospitalization for chest pain and dyspnea but did not follow up in the outpatient setting.
Physical exam, diagnostic, and laboratory findings:
- BP: 100/63
- pulse: 108 beats/minute
- patient appeared sleepy
- ECG: aFib with intermittent PVC
- X-ray: cardiomegaly with bilateral pulmonary edema.
- Creatinine: 3.8 mg/dL
- eGFR: 16 mL/min/1.73 m2
- elevated N-type pro-brain natriuretic peptide level
Transthoracic echocardiography revealed an ejection fraction of 33%
How would you manage this patient? What are the next steps to take in the diagnostic workup? How do you and the Heart Team decide whether TAVR is appropriate? What measurements do you look for when making that determination?
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Ramakota Reddy4yrWe do not know the etiology of her LV dysfunction, if potentially reversible diagnostic workup should initially revolve around that: (1) Potentially tachycardia mediated CM from longstanding AF with Show More
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Chakravarthy Raghavan4yrNeed to know about the duration of atrial fibrillation. Will stabilize patient with IV diuretics, TEE followed by cardioversion to restore sinus rhythm, when renal parameters are stable RHC/LHC with Show More
