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Symptom Based Echocardiographic Approach: Dyspnea. Dae-Won Sohn, M.D. Department of Internal Medicine, Seoul National University College of Medicine. Work of breathing. Respiratory rate. Lung compliance. . . Dyspnea. Pulmonary edema Cardiogenic Non-cardiogenic
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Symptom Based Echocardiographic Approach: Dyspnea Dae-Won Sohn, M.D. Department of Internal Medicine, Seoul National University College of Medicine
Work of breathing Respiratory rate Lung compliance Dyspnea Pulmonary edema Cardiogenic Non-cardiogenic Other parenchymal diseases Low cardiac output Anemia Hypoxia Metabolic acidosis
Resting Dyspnea 이 환자의 수축기기능저하가 운동시호흡곤란의 원인이 되는가? 이 환자의 수축기기능저하가 안정시호흡곤란의 원인이 되는가?
Resting Dyspnea 수축기기능이 정상이므로 안정시 호흡곤란의 원인이 될 수 없다. 수축기기능이 정상이므로 운동시 호흡곤란의 원인이 될 수 없다.
Exertional dyspnea Exertional dyspnea LV dysfunction ? Resting dyspnea Resting dyspnea Normal LV function ? ? Resting Dyspnea
Resting Dyspnea: Pulmonary edema LA pr - LV diastolic pr(LV filling pr) - excluding MS - “ Doppler findings ” Qualitative: Restrictive physiology Quantitative: E/E’
Resting Dyspnea: Pulmonary edema Restrictive physiology
Resting Dyspnea: Pulmonary edema Mitral annulus velocity
E filling pressure = myocardial relaxation E filling pressure = E’ Resting Dyspnea: Pulmonary edema E filling pressure(LVDP) * myocardial relaxation
Resting Dyspnea: Pulmonary edema E/E’ 10 PCWP 12mmHg: Sensitivity 91%, Specificity 81% Nageuh SF et al. J Am Coll Cardiol, 1997
Resting Dyspnea: Pulmonary edema Ommen SR et al. Circulation, 2000
Resting Dyspnea: Pulmonary edema Quantitative estimation Pre A pressure = 0.96 E/E’ + 3.78 (LVDP) Simplified equation Pre A pressure = E/E’ + 4 3mmHg in 77% > 5mmHg in only 8%
Resting Dyspnea: Hypoxia 50 YO female with sudden dyspnea
Resting Dyspnea: Hypoxia 50 YO female with sudden dyspnea P = 40mmHg
Resting Dyspnea: Hypoxia 69 yo woman with liver cirrhosis, dyspneaPaO2:43mmHg, PaCO2:27mmHg
Resting Dyspnea: Hypoxia 30 YO female with dyspnea
Resting Dyspnea: Hypoxia P = 135mmHg
Exertional dyspnea Systolic heart failure vs Diastolic heart failure
Exertional dyspnea Systolic heart failure: Low CO Preload Afterload HR Contractility
Preload Afterload Contractility HR Exertional dyspnea Small LV cavity size with hyperdynamic systolic function - ? volume depletion Pericardial ds. - effusion, constriction Pulmonary hypertension – resting, exercise Diastolic filling period Presence of LVOT obstruction or AS EF, evaluation of stroke volume during exercise HR
A E Exertional dyspnea Diastolic heart failure: Relaxation abnormality “ Prevention of tachycardia ”
Exertional dyspnea Normal Relaxation Abnormality Psuedo- normalization Restrictive Physiology LA pressure
Exertional dyspnea Sohn DW et al. J Am Coll Cardiol, 1997
Exertional dyspnea 50 YO male with diabetes Baseline Exercise AP4C AP2C
Exertional dyspnea 50 YO male with diabetes