lucky_doc
Forum Junior
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a 72 yo F presents to the clinic with a cc of weakness and fatigue. she has had difficulty breathing over the past several weeks and now must sleep on two pillows at night to get comfortable. In addition, she reports an episode of syncope last week. Cardiac biopsy reveals amyloid deposits. Which of these findings is consistent with the biopsy results?
A Ejection fraction of 55% on echo
B Harsh diastolic murmur
C RLQ abdominal mass
D Upper extremity edema
E U waves on ECG
F Wheezing on lung examination
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| RX 135
tormenta
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Posts: 522
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b/f...orthopnea lt heart failur..followin ms..
amyloidosi can be due old age..
not sure ans please
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| Adam
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C - RLQ abdominal mass
could be D ( due to nephrotic syndrome) but i think that would be upper and lower extremities edema...
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| brutus25
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E - U waves on ECG
May be you could post the answer pls , also could you tell us where are these questions coming from? Thank you
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| farnsworth
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A?
EF55% does not mean that the cardiac output is sufficient: cardiac output (CO) = stroke volume (SV) x heart rate (HR)
HR: Patients with amyloidosis tend to have cardial conductance impairment (bradycardia, AV block)
SV: can be decreased, despite a normal EF!
remember calculation of EF and SV (done by transesophageal echocardiography)
SV=area x VTI
area = (D/2)^2 x pi (D: diameter of a great vessel, usually left ventricular outflow tract, LVOT), VTI: velocity time intregral assessed by pulsed wave doppler
EF: can be measured in different ways: a) (end-diastolic - end-systolic area)/(end-diastolic area) x 100 (transgastral short axis)
b) biplane mode (mid-esophageal 4 chamber or 2 chamber): EF(%)=(LVEDV-LVESV)/LVEDVx100
So if amyloidosis leads to segmental myocardial abnormalities, the EF tends to be overestimated (in my opinion the determination of EF using method a) is more susceptible to errors due to wall motion abnormalities, determination of SV is mandatory in this case) and cardiac output might be decreased -> heart failure (especially in conbination with bradycardia/AV block).
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| drshvetasm
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A
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| Ivonne
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A Restrictive cardiomyopathy----------->amyloidosis
The granular sparkling (ie, scintillating) appearance on 2-dimensional echocardiography may be present and is typical, but not diagnostic, of cardiac amyloidosis. Echocardiography more typically shows biventricular thickening out of proportion to current or prior hypertension, biatrial enlargement, a restrictive filling pattern by Doppler echocardiography, and normal systolic function/EF until late in the disease.
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| Korotkoff
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A!!
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| arlete
Intern in 2009!!!!!
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Agree with Ivonne. 
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| lucky_doc
Forum Junior
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The answer indeed is A !!! An ejection fraction of 55% is consistent with Diastolic Dysfuntion 
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