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Symptom Based Echocardiographic Approach: Dyspnea

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

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  1. Symptom Based Echocardiographic Approach: Dyspnea Dae-Won Sohn, M.D. Department of Internal Medicine, Seoul National University College of Medicine

  2.  Work of breathing  Respiratory rate  Lung compliance   Dyspnea  Pulmonary edema Cardiogenic Non-cardiogenic  Other parenchymal diseases  Low cardiac output  Anemia  Hypoxia  Metabolic acidosis 

  3. Resting Dyspnea 이 환자의 수축기기능저하가 운동시호흡곤란의 원인이 되는가? 이 환자의 수축기기능저하가 안정시호흡곤란의 원인이 되는가?

  4. Resting Dyspnea 수축기기능이 정상이므로 안정시 호흡곤란의 원인이 될 수 없다.  수축기기능이 정상이므로 운동시 호흡곤란의 원인이 될 수 없다.

  5. Exertional dyspnea Exertional dyspnea LV dysfunction ? Resting dyspnea Resting dyspnea Normal LV function ? ? Resting Dyspnea

  6. Resting Dyspnea: Pulmonary edema  LA pr - LV diastolic pr(LV filling pr) - excluding MS - “ Doppler findings ” Qualitative: Restrictive physiology  Quantitative: E/E’

  7. Resting Dyspnea: Pulmonary edema Restrictive physiology

  8. Resting Dyspnea: Pulmonary edema Mitral annulus velocity

  9. E  filling pressure = myocardial relaxation E  filling pressure = E’ Resting Dyspnea: Pulmonary edema E  filling pressure(LVDP) * myocardial relaxation

  10. Resting Dyspnea: Pulmonary edema

  11. Resting Dyspnea: Pulmonary edema E/E’ 10 PCWP 12mmHg: Sensitivity 91%, Specificity 81% Nageuh SF et al. J Am Coll Cardiol, 1997

  12. Resting Dyspnea: Pulmonary edema Ommen SR et al. Circulation, 2000

  13. 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%

  14. Resting Dyspnea: Pulmonary edema

  15. Resting Dyspnea: Hypoxia 50 YO female with sudden dyspnea

  16. Resting Dyspnea: Hypoxia 50 YO female with sudden dyspnea  P = 40mmHg

  17. Resting Dyspnea: Hypoxia 69 yo woman with liver cirrhosis, dyspneaPaO2:43mmHg, PaCO2:27mmHg

  18. Resting Dyspnea: Hypoxia 30 YO female with dyspnea

  19. Resting Dyspnea: Hypoxia  P = 135mmHg

  20. Resting Dyspnea: Hypoxia

  21. Exertional dyspnea Systolic heart failure vs Diastolic heart failure

  22. Exertional dyspnea Systolic heart failure: Low CO  Preload  Afterload  HR  Contractility

  23. 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

  24. A E Exertional dyspnea Diastolic heart failure: Relaxation abnormality “ Prevention of tachycardia ”

  25. Exertional dyspnea Normal Relaxation Abnormality Psuedo- normalization Restrictive Physiology LA pressure

  26. Exertional dyspnea Sohn DW et al. J Am Coll Cardiol, 1997

  27. Exertional dyspnea 50 YO male with diabetes Baseline Exercise AP4C AP2C

  28. Exertional dyspnea 50 YO male with diabetes

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