Dyspnea, Orthopnea, and Pedal Edema



Dyspnea, Orthopnea, and Pedal Edema





A 67-year-old man with a history of hypertension presents with 3 months of increasing dyspnea, orthopnea, and lower extremity edema. His transthoracic echocardiogram is shown in Figures 56-1, 56-2 and 56-3.






Figure 56-1A,B.






Figure 56-2A,B.






Figure 56-3A,B.




QUESTION 1. All of the following would support a diagnosis of severe aortic regurgitation (AR) except:


A. Jet width > 65% left ventricular outflow tract (LVOT)

B. Regurgitant fraction > 50%

C. Regurgitant volume > 50 mL per beat

D. Holodiastolic flow reversal

E. None of the options

View Answer

ANSWER 1: C. A regurgitant volume > equal to 60 mL per beat is highly suggestive of severe AR and not 50 mL per beat (Table 56-1).








TABLE 56-1. Qualitative and Quantitative Parameters Useful in Grading Aortic Regurgitation Severity


Mild

Moderate

Severe


Structural parameters

LA size

Normal

Normal or dilated

Usually dilated

Aortic leaflets

Normal or abnormal

Normal or abnormal

Abnormal/flail or wide coaptation defect


Doppler parameters

Jet width in LVOT -Color Flow

Small in central jets

Intermediate

Large in central jets; variable in eccentric jets

Jet density-CW


Jet deceleration rate – CW (PHT, ms)

Incomplete or faint slow > 500

Dense Medium 500-200

Dense Steep < 200

Diastolic flow reversal in descending aorta -PW

Brief, early diastolic reversal

Intermediate

Prominent holodiastolic reversal


Quantitative parameters

VC width, cm

< 0.3

0.3-0.60

> 0.6

Jet width/LVOT width, %

< 25

25-45

46-64

≥ 65

Jet CSA/LVOT CSA, %

<5

5-20

21-59

≥ 60

R Vol, ml/beat

< 30

30-44

45-59

≥ 60

RF, %

< 30

30-39

40-49

≥ 50

EROA, cm2

< 0.10

0.10-0.19

0.20-0.29

≥ 0.30


Reprinted from Zoghbi WA, Enriquez-Sarano M, Foster E, et al. Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr. 2003; 16:777-802, with permission from Elsevier.

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Jul 15, 2016 | Posted by in CARDIOLOGY | Comments Off on Dyspnea, Orthopnea, and Pedal Edema

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