Cardiovascular Case Histories A 32-year-old nurse who had rheumatic fever as a child noticed a persistent tachycardia and light-headedness. Upon examination, chest x-rays showed an enlarged left atrium and left ventricle. ECG analysis showed atrial fibrillation. There was also mild pulmonary edema. Cardiac evaluation resulted in the following information: Cardiac output (CO) 3.4 L/min Blood pressure (BP) 100/58 mm Hg Left atrial pressure (LAP) 16 mm Hg (normal 8-
Cardiovascular Case Histories
A 32-year-old nurse who had rheumatic fever as a child noticed a persistent tachycardia and light-headedness. Upon examination, chest x-rays showed an enlarged left atrium and left ventricle. ECG analysis showed atrial fibrillation. There was also mild pulmonary edema. Cardiac evaluation resulted in the following information:
|
Cardiac output (CO) |
3.4 L/min |
|
Blood pressure (BP) |
100/58 mm Hg |
|
Left atrial pressure (LAP) |
16 mm Hg (normal 8-10) |
|
Right ventricular pressure (RVP) |
44/8 mm Hg (normal 25/4) |
|
Heart Rate (HR) = 120 bpm
Heart sounds revealed valvular regurgitation. |
- Based on the information provided, which A-V valve is incompetent, allowing the regurgitation? How did you determine this?
- If the other A-V valve were incompetent instead of this one, would the CO (L ventricle), and BP be different? If so, how? Would you expect the LAP to be normal?
- Pulmonary hypertension can develop with L sided heart disease. What is pulmonary hypertension in this context? Why does it cause elevated RVP?
- Other than atrial fibrillation, what are the causes of the tachycardia, light-headedness, and mild pulmonary congestion in this patient?
- Does the cardiac output concern you? Why or why not?
- Name a danger/risk associated with atrial fibrillation.
The patient was untreated and presented a few years later with severe symptoms, including shortness of breath, extreme fatigue, diffuse peripheral edema and ascites (fluid accumulation in the abdominal cavity). Cardiac echocardiogram results:
Heart Rate (HR) 100 bpm
End-systolic volume (ESV) 140 mL
End-diastolic volume (EDV) 170 mL
- Are the above values of ESV and EDV normal, high or low?
- Calculate the stroke volume (SV), ejection fraction (EF), and cardiac output (CO) (show calculations).
- What do you suspect is causing the new symptoms of peripheral edema and ascites?
- Define Frank-Starling Law. How does it apply in this case considering the above values of ESV and EDV.?
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