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MitraClip and Transcatheter Aortic Valve Replacement in a Patient With Recurrent Heart Failure
- Source :
- Circulation: Cardiovascular Interventions. 10
- Publication Year :
- 2017
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2017.
-
Abstract
- An 85-year-old man presented to the emergency department with a 3-week history of progressive dyspnea, orthopnea, and mild ankle edema without chest discomfort. His past medical history was significant for coronary artery disease with a non–ST-segment–elevation myocardial infarction 8 years prior with percutaneous coronary intervention to the distal right coronary artery, with mild residual nonobstructive disease in the left anterior descending artery and circumflex artery. Cardiovascular risk factors included hypertension, dyslipidemia, and chronic kidney disease stage 3. His remaining medical history was significant for cecal adenocarcinoma with a right hemicolectomy 20 years prior, and pulmonary sarcoidoisis that was quiescent without any history of steroid use or immunosuppression. The most recent pulmonary function tests revealed normal spirometry and diffusion capacity. He was a nonsmoker, and before the onset of symptoms he was functionally independent only using a cane for mobility. Initial vital signs revealed a regular heart rate of 81 bpm, and blood pressure of 121/78 mm Hg. He was afebrile, and his oxygen saturation was 95% on 2-L nasal prongs. Jugular venous pressure was elevated at 7 cm above the sternal angle with a normal waveform; the hepatojugular reflex was positive. The carotid pulse was of decreased volume but normal contour, without audible bruits. Auscultation revealed a normal S1 and S2, a holosystolic murmur at the apex, and a grade 2 midpeaking systolic ejection murmur at the base, with radiation to the carotids. Respiratory examination revealed clear and equal breath sounds bilaterally with the presence of bibasilar crackles at the lung bases. Peripheral pulses were present, with bilateral pitting edema at the ankles. Abdominal examination was unremarkable. Initial investigations revealed hemoglobin of 103 g/dL, and electrolytes within the normal range with a creatinine of 121 mmol/L (estimated glomerular filtration rate 50 mL/min). Troponin I (high sensitivity) was elevated with peak of …
- Subjects :
- Male
medicine.medical_specialty
Orthopnea
medicine.medical_treatment
030204 cardiovascular system & hematology
Prosthesis Design
Jugular venous pressure
Pulmonary function testing
Transcatheter Aortic Valve Replacement
Coronary artery disease
03 medical and health sciences
0302 clinical medicine
Recurrence
Internal medicine
medicine
Humans
030212 general & internal medicine
Myocardial infarction
Aged, 80 and over
Heart Failure
Heart Valve Prosthesis Implantation
business.industry
Hemodynamics
Mitral Valve Insufficiency
Percutaneous coronary intervention
Aortic Valve Stenosis
medicine.disease
Echocardiography, Doppler, Color
Treatment Outcome
Blood pressure
Aortic Valve
Heart Valve Prosthesis
Heart failure
Cardiology
Mitral Valve
medicine.symptom
Cardiology and Cardiovascular Medicine
business
Echocardiography, Transesophageal
Echocardiography, Stress
Subjects
Details
- ISSN :
- 19417632 and 19417640
- Volume :
- 10
- Database :
- OpenAIRE
- Journal :
- Circulation: Cardiovascular Interventions
- Accession number :
- edsair.doi.dedup.....6da62f25aa4e549f4fdb29a635d7e600