new_n_lost
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A. 55 year old patient presented with breathlessness and ankle oedema. The blood pressure is 135/80 mmHg. On examination, her JVP rises with inspiration. She has a soft systolic murmur and a third heart sound. Blood tests reveal
Hb 10.5 g/dl
WCC 7.5 x 10^9/l
Platelets 150x 10^9/l
Sodium 136 mmol/l
Potassium 3.5 mmol/l
Creatinine 140 µmol/l
Urea 6 µmol/l
ECG shows poor R wave progression. An echocardiogram shows no pericardial effusion, the ventricles are stiff and systolic function is mildly impaired.
Which of the following is the likely diagnosis?
A. Restrictive cardiomyopathy
B. Dilated cardiomyopathy
C. Constrictive pericarditis
D. Ischaemic cardiomyopathy
E. Pulmonary embolus
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| Aashi
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C. uremic pericarditis--------->s3--->pericardial knock
Restrictive C.M--->is a diastolic dysfunction
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| usmle4me
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ECG shows no pericardial effusion?!!!
So left with CM shouldn't it be A
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| new_n_lost
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FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
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| new_n_lost
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Answer: A) Restrictive cardiomyopathy.
In this scenario, there symptoms can be caused by any form of cardiomyopathy. The rise in JVP with inspiration suggests either constrictive or restrictive cardiomyopathy. Echocardiography showing no pericardial effusion and stiffness suggests restrictive rather than constrictive cardiomyopathy. The transmitral Doppler’s on the echo may show E/A wave reversal and high velocities which may suggest restrictive picture. This may be due to infiltration due to haemochromatosis, endomyocardial fibrosis, sarcoidosis, myeloma, lymphoma or connective tissue disease.
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FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
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