Cases of Diastolic Heart Failure

35-Year-Old African American Man With Suspected Left Ventricular Hypertrophy

• History: 35-year-old African American athlete referred for evaluation of suspected left ventricular hypertrophy based on an electrocardiogram (ECG) obtained during his annual screening. He is otherwise completely asymptomatic.

• Past medical history: None

• Past surgical history: Fractured left tibia

• Social: Denies any smoking or alcohol consumption

• Physical exam:

  • Pulse: 47 bpm, sinus rhythm

  • Blood pressure: 120/75 mmHg

  • Neck: No elevation of jugular venous pressure (JVP), no carotid bruits, no masses

  • Chest: Lungs are clear to auscultation

  • Cardiovascular: S ₁ , S ₂ normal, no murmurs

  • Abdomen: No tenderness, organomegaly, palpable masses, or bruits, normal bowel sounds

  • Extremities: No edema

ECG

• See Video 37.1 : 2-D parasternal long axis.

• See Video 37.2 : 2-D parasternal long axis with color Doppler.

• See Video 37.3 : 2-D apical four chamber.

• See Video 37.40 : 2-D apical two chamber.

• See Video 37.5 : 2-D apical three chamber.

LV-End Diastolic Dimensions M-Mode Parasternal Long-Axis.

Pulsed-wave Doppler LV Inflow.

Tissue Doppler Lateral Mitral Annulus.

Tissue Doppler Septal Mitral Annulus.

LA Volume.

Tricuspid Regurgitation on Continuous Wave Doppler.

65-Year-Old Caucasian Female Referred for Poorly Controlled Hypertension

• History: 65-year-old Caucasian female was referred by her primary care physician for poorly controlled essential hypertension. She reports mild exertional dyspnea. She denies chest pain, orthopnea, paroxysmal nocturnal dyspnea, or lower extremity edema.

• Past medical history: Normocytic anemia, essential hypertension

• Past surgical history: None

• Social: Occasional alcohol and social smoker

• Physical exam:

  • Pulse: 75 bpm, sinus rhythm

  • Blood pressure: 175/92 mmHg

  • Neck: JVP at the level of the jaw, no carotid bruits, no masses

  • Chest: Decreased air entry to the bases

  • Cardiovascular: S ₁ , S ₂ normal, grade II/VI systolic murmur at the left sternal border

  • Abdomen: No tenderness, organomegaly, palpable masses or bruits, normal bowel sounds

  • Extremities: Mild bilateral pitting edema

ECG: Sinus Rhythm.

• See Video 37.6 : 2-D parasternal long axis.

• See Video 37.7 : 2-D parasternal long axis with color Doppler.

• See Video 37.8 : 2-D apical four chamber.

• See Video 37.9 : 2-D apical two chamber.

• See Video 37.10 : 2-D apical three chamber.

LV End-Diastolic Dimensions, M Mode Parasternal Long Axis.

Pulsed-wave Doppler LV Inflow.

Tissue Doppler Lateral Mitral Annulus.

Tissue Doppler Medial Mitral Annulus.

LA Volume.

Tricuspid Regurgitation on Continuous Wave Doppler.

47-Year-Old African American Man With Multiple Myeloma Being Evaluated for Lower Extremity Edema and Dyspnea

• History: 47-year-old African American man was recently diagnosed with multiple myeloma (kappa light chain) when being investigated for anemia. His anemia has since resolved, but he is now complaining of external dyspnea, palpitations, and lower leg edema. An echocardiogram was ordered.

• Past medical history: Multiple myeloma, anemia, asthma, dyslipidemia, pleural effusion of unknown etiology, carpel tunnel

• Past surgical history: None

• Social: No alcohol or smoking

• Current medications: Budesonide, torsemide, eplerenone, bortezomib-dexamethasone

• Physical exam:

  • Pulse: 75 bpm sinus rhythm

  • Blood pressure: 125/81 mmHg

  • Neck: JVP at the level of the jaw, no carotid bruits, no masses

  • Chest: Crackles at the base of the right lung

  • Cardiovascular: S ₁ , S ₂ normal, S ₃ , no murmur

  • Abdomen: No tenderness, organomegaly, palpable masses, or bruits, normal bowel sounds

  • Extremities: Mild bilateral pitting edema

ECG

• See Video 37.11 : 2-D parasternal long axis.

• See Video 37.12 : 2-D parasternal long axis with color Doppler.

• See Video 37.13 : 2-D apical four chamber.

• See Video 37.14 : 2-D apical two chamber.

• See Video 37.15 : 2-D apical three chamber.

LV End-Diastolic Diameter, 2-D Parasternal Long Axis.

Pulsed-wave Doppler LV Inflow.

Tissue Doppler Lateral Mitral Annulus.

Tissue Doppler Medial Mitral Annulus.

LA Volume.

Tricuspid Regurgitation on Continuous Wave Doppler.

Global Longitudinal Strain.